1806 106TH ST SW 2025-01-14 - Laserfiche WebLink

BUILG PERMIT APPLICATIOA 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 j(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1806 106TH ST SW PARCEL#: 00710300005100 c EVERETT STATE WA ZIP 98204 SUITE/UNIT#: N/A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): N/A TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: 42 of Plats Lot No.: 51 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:PAGIJACK FYE AND MEKDES CROWLEY FYE OWNER MAILING ADDRESS: STREET 1806 106TH ST SW cm, EVERETT STATE WA ZIP 98204 OWNER PHONE:(206)471-4594 OWNER EMAIL: JACKEYFYE16@GMAIL.COM CONTRACTOR COMPANY NAME:- 0'- R 6r- WA STATE CONTRACTOR LICENSE#(REQUIRED): N/A CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N/A CONTRACTOR ADDRESS: STREET N/A CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: PAGIJACK FYE CONTACT PHONE:(206)471-4594 CONTACT EMAIL: JACKEYFYE16@GMAIL.COM BUILDING INFORMATION VALUATION OF WORK:$ 5/0 0 C) 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 Resident PROPOSED USE OF BUILDING: Adult Family Home HEAT SOURCE: ❑✓Gas ❑✓Electric ❑Other BUILDING TYPE: ❑✓1SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑✓Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: RECEIIVE\i" � otv & rat oui MAY 23 2024 CITY OF EVERETT Permit Services 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 Official before being authorized 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everettre Official Use Only Cr) [ - Ivz PERMIT# �U\`J 0 (( /nl/ Owner/Authorized Agent Signature Date (Revised 4/21/2022)