1725 106TH ST SW 2024-11-07 - Laserfiche WebLink

ElIN uroi ISILDING PERMIT APPLICATIN CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1725 106th St SW PARCEL#: 0074590000170 cry Everett STATE WA ZIP 98204 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Mimi Gebremariam OWNER MAILING ADDRESS: STREET 15324 45th PI W CITY Lynnwood ,STATE• WA ZIP 98087(� OWNER PHONE:206-234-2892 -- EMAIL: 1/�( �� , C' n JC. • CONTRACTOR COM Y NAME:TBD WA STATE CONT CTOR LICENSE#(REQUIRED): CITY OF EV ETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADD S: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER E CONTRACTOR ❑✓ OTHER(Please Specify) Owner's Agent CONTACT NAME: CONTACT PHONE:425-345-2530 Dante Palm affy CONTACT EMAIL:Dpalmaffy@aol.com BUILDING INFORMATION VALUATION OF WORK:$200,000.00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:Single-family Residence w13.5„fOt 1 PROPOSED USE OF BUILDING:AdUIt Faamily Home �- �-f HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: I ISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): El New Construction ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure El Fence over 7ft high ❑RackStorage LiPool/Hot Tub ❑Tank(above ground) ❑✓Other:Garage Conversion DESCRIPTION OF WORK:Remodel residence and convert existing garage into living s ace reside house can be used as an Adult Family Home. [EC t � ��cr`'�`� �?'� yeowk- JUL 2 7 2023 to k cks.p r ,tedu7\)( . .` � Cet Ai, ClRerr OF SQaRes ETT ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Offici efore being a orized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comp) i the State Co tr tors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 7(x2-3 PERMIT# n 01 J N Own r/Authorized Agent Signatur Da (Revised 4/21/2022) ✓j