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LLB BUILDING PERMIT APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <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 (E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 10406 Holly Dr PARCEL#: <br /> CITY Everett STATE WA z r 98204 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Port Gardner 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 Gardner Property Management <br /> OWNER MAILING ADDRESS: STREET 11331 8th PI W <br /> clry Everett STATE WA zip 98204 <br /> OWNER PHONE:4252589325 OWNER EMAIL: tgish@portgardnermgmt.com <br /> CONTRACTOR COMPANY NAME:Four Seasons Roofing <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):FOURSRS016QA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 36927 <br /> CONTRACTOR ADDRESS: STREET 17903 SR 9 SE <br /> CITY Snohomish S <br /> TA.C T- WA zip 98296 <br /> CONTRACTOR PHONE:(425)388-9906 CONTRACTOR EMAIL:tiana@fourseasonsroofing.com <br /> PRIMARY CONTACT: ❑OWNER L✓l CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425) 388-9906 <br /> Tana Brown CONTACT EMAIL:tana@fourseasonsroof.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$32.200 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 ❑✓Mufti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): El New Construction ❑Addition ERemodel ❑Repair ❑T.I. ❑Change of Use <br /> EModular EPortable ['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 i am authorized by the owner of this property to perform the work for which application is made. <br /> and f comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Tiana Cooper Gate:20210z2810:03s5 og c 8/18/22 - <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> /,7 <br />