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BOLDING PERMIT APPLICADN <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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1525 75th St. SW PARCEL#: 28041100100500 <br /> ciTy Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: 100 FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Cascade Coffee <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Johnson Properties I LLC <br /> OWNER MAILING ADDRESS: STREET PO BOX 5253 <br /> CITY Everett STATE WA ZIP 98206 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:TBD <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):TBD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): TBD <br /> CONTRACTOR ADDRESS: STREET TBD <br /> CITY TBD STATE TBD zip TBD <br /> CONTRACTOR PHONE:TBD CONTRACTOR EMAIL:TBD <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Engineer <br /> CONTACT NAME: CONTACT PHONE:714.-472-3007 <br /> SGE Consulting Engineers(Contact.Edward Alvarado) <br /> CONTACT EMAIL:pm @sgeconsulting.com <br /> • BUILDING INFORMATION <br /> VALUATION OF WORK: $65,000 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 /> EXISTING USE OF BUILDING:N/A <br /> PROPOSED USE OF BUILDING:N/A <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <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 ❑T.l. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑✓Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ✓❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Foundation and anchorage of a 9,000 gallon liquid nitrogen tank and associated <br /> vaporizer. Project will be outside, no change to existing structure. <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,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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 6 / /eZ ' PERMIT# B 2- i 0 -7 -- 6 3 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) 1 <br /> C aWo-r'S A(n/Ym.rq10 I% <br />