909 SE EVERETT MALL WAY CUP AND CREPE 2022-06-24

az BODING PERMIT APPLICATON 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)everetteps@everettwa.gov I(W)everettwa.govlpermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET9O9 SE Everett Mall Way PARCEL#: 28051800300400 CITY Everett STATE WA ZIP 98208 SUITE/UNIT#: E550 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):CUp & Crepe LLC `LEGAL DESCRIPTION for new construction: Short Plat/subdivision: see attached Lot No.:attached (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:TereSa Godfrey OWNER MAILING ADDRESS: STREET 909 SE Everett Mall Way CITY Everett STATE WA ZIP 98208 OWNER PHONE:206-235-l865 OWNER EMAIL:/ �� teresa@cupandcrepe.com CONTRACTOR COMPANY NAME: > eJ) 5 0V 614, (9 c WA STATE CONTRACTOR LICENSE#(REQUIRED): . 6-E15(‘) CS6a3X3 jTY OF EVERETT BUSINESS LICENSE#(REQUIRED): , . CONTRACTOR ADDRESS: STREET( S. CITY , _ STATE - -- ZIP CONTRACTOR PHONE: _ CONTRACTOR EMAIL: PRIMARY CONTACT: O OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206_235-1865 Teresa Godfrey CONTACT EMAIL:teresa@cupandcrepe.com 1 BUILDING INFORMATION VALUATION OF WORK: $ 4 t 0 00 ASSOCIATED LAND USE PROJECT#(if applicable):N/A (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:VaCant PROPOSED USE OF BUILDING:COffee shop HEAT SOURCE: ❑Gas Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): El New Construction ❑Addition ORemodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration OTank(above ground) ❑Accessory Structure OFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Create internal portioning wall, install sinks, and counter for coffee shop. I ACKNOWLEDGEMENT:I have reviewed his ap,ratio I. onfirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The-,rant! g o .per I. authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized nthecircu .ance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors aw RC , and 296.200A WAC. 1' City of Everett Official Use Only 14OPP PERMIT# /&LW, / e�/,4/ . , . 2/4/22 .2��r Owner/Authorized Agent 6fgnatu , Date (Revised 2/8/2021) )