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ma <br /> in BU•DING PERMIT APPLICATI.I <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 /> 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(u�everettwa.gov I(W)everettwa.aov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 11108 Evergreen way Suite E PARCEL#: 00442900300700 <br /> cm, Everett STATE Wash. ZIP 98204 <br /> SUITE/UNIT#: E FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Alem Market <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Enat Wendemeneh <br /> OWNER MAILING ADDRESS: STREET 11108 Evergreen Way Suite E <br /> CRY Everett STATE Wash. ZIP 98204 <br /> OWNER PHONE:296.439'001U 206 3Cj O p — 9-�5COWNER EMAIL: .A\pAv.) h/1a,\ '\e.,-L- 1 (°? (y)a;1 • cow)y <br /> CONTRACTOR COMPANY NAME:TBD. Car 1 os .1 wtkX- Cans t Seer- h L2 S <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CAR L G H C 0 1+t (4CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Co 1 c 7 5 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 1 CONTACT PHONE: .jOE ?jq?3 -t�q'Lfs° <br /> I✓h w 4- ( W1 en(�,s`'', CONTACT EMAIL: ,41 0,� r -Q-i—2-I &9 .1",,A1 I� ex j <br /> I BUILDING INFORMATION <br /> VALUATION OF WORK: $50,000 (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:Retail <br /> PROPOSED USE OF BUILDING:Grocery store <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.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:Change to limited grocery store with kitchen for take out food. <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 /> Eil PERMIT# <br /> % /3O)Zozf 22O"-i f OO1 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) ,/ <br /> '//Z <br />