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• • <br /> SIM <br /> ix BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 811 SE Everett Mall Way PARCEL#: 28051800307400 <br /> cm' Everett STATE WA ZIP 98208 <br /> 5UITE/UNI FLOOR#:Maine Level ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/8 ' SS NAME(if non-residential): Olypmic Hot Tub <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: RMD Development&Property Management, LLC - Rep: Ryan Dosch <br /> OWNER MAILING ADDRESS: STREET 6219 252nd PL Northeast <br /> ciTr Bellevue STATE WA zip 98004 <br /> OWNER PHONE: 206-992-7334 (OWNER EMAIL: Rmdproperty@hotmail.com <br /> CONTRACTOR COMPANY NAME: Powell RYKA <br /> ^ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CC POWELCCO27L3CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62973 <br /> CONTRACTOR ADDRESS: STREET 2625 Northup Way <br /> CnY Bellevue STATE WA ZIP 98004 <br /> CONTRACTOR PHONE: 425.828.4774 CONTRACTOR EMAIL: kbrehm@powellryka.com <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑✓ OTHER(Please Specify) Designer <br /> CONTACT NAME: CONTACT PHONE:253.217.9074 <br /> Edith B u kenya CONTACT EMAIL: e.bukenya@crestedcraneinteriors.corrl <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$291,000.00 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> — <br /> EXISTING USE OF BUILDING: Mixed Use <br /> PROPOSED USE OF BUILDING: No change <br /> HEAT SOURCE: ❑Gas ©Electric DOther <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair DTI. ❑Change of Use <br /> ❑Modular DPortable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high DRackStorage OPool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Construction of new partitions, doors, installation of new ceilings types in a protion of <br /> the suite, , and one private restroom. <br /> 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 <br /> current federal,stale,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 <br /> Building Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/com.,j'r, the State Contractor 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ;4�P <br /> 02.24.2021 PE 16 ,ps ©l v <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> kiL <br />