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0 0 <br />BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />wASHtNGTON 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 5809 Highway Place PARCEL #: Building A <br />CITY Everett STATE WA ZIP 98203 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): Port Gardener Property Management <br />LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Port Gardener Property Management <br />OWNER MAILING ADDRESS: STREET 2907 Hewitt Ave <br />CITY Everett STATE WA ZIP 98201 <br />OWNER PHONE: (425) 2589325 <br />OWNER EMAIL: tgish@portgardnermgmt.com <br />CONTRACTOR COMPANY NAME: Four Seasons Roofing <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): FOURSRS016QA <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 36927 <br />CONTRACTOR ADDRESS: STREET 17903 SR 9 SE <br />c ITY Snohomish STATE WA ZIP 98296 <br />CONTRACTOR PHONE: (425) 388-9906 <br />CONTRACTOR EMAIL: tiana@fourseasonsroofing.com <br />PRIMARY CONTACT: ❑ OWNER ❑✓ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Tiana Cooper <br />CONTACT PHONE: (425) 388-9906 <br />CONTACT EMAIL:tiana@fourseasonsroof.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 22,000 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: Multifamily <br />PROPOSED USE OF BUILDING: Multifamily - no Change <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 LIT. I. ❑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: <br />Remove existing shingles to roof deck, provide underlayment and asphalt shingles. <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 / am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Tiana Cooper oa9'ea202 nz261DD ss.nen 2126/21 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />(Revised 21812021) <br />