2623 GRAND AVE 2025-09-30 - Laserfiche WebLink

BUIL LNG PERMIT APPLICATIO �� M CITY OF EVERETT PERMIT SERVICES I_' .� E V E R E T T SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal require q r1 and number of copies require( review, WASHINGTON then drop off completed application plus all required submittal documents t 0 CedVftreLt/2nd)@0a3;r Intak p Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettw I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OF E V ERETT PROJECT SITE ADDRESS: STREET 2623 Grand Ave PARCEL#: 00436),eirolt0ServiceS cm Everett STATE WA z,P 98201 SUITE/UNIT#: FLOOR#: 1 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:2623 Grand Ave LLC OWNER MAILING ADDRESS: STREET P O Box 1094 clT, Woodinville STATE WA ZIP 98072 OWNER PHONE:425.244.0007 OWNER EMAIL: ismail.seattle@gmail.com CONTRACTOR COMPANY NAME:4ef �Qi✓� WA STATE CONTRACTOR LICENSE#REQUIRED:��' —� ( ) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): . CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Designer CONTACT NAME: CONTACT PHONE:206.669.2026 Selena Fitch CONTACT EMAIL:Selena@fitchdesigncompany.com BUILDING INFORMATION VALUATION OF WORK:$15,000 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 Home PROPOSED USE OF BUILDING:Duplex HEAT SOURCE: ❑✓Gas []Electric ❑Other BUILDING TYPE: ❑✓SFR ❑Townhouse ❑Duplex ❑ADU []Multi-Family-#U its: 1 ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction Addition emodel ❑Repair ❑TJ. hange 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:Converting into Duplex DESCRIPTION OF WORK: Dividing the unit into a Duplex. Dividing wall with one hour rating and connected fire alarms. Adding Kitchen and bathroom to the new open space. 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.1 am the owner,or l am authorized by the owner of this property to perform the work for which application is made, and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# A I V 12/05/2023 3� Owner/Authorized Agent Signature Date (Revised 412112022)