5700 23RD DR W 2022-12-30 - Laserfiche WebLink

1011111 BIDING PERMIT APPLICATIN 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5700 23rd Drive PARCEL#: 28040200200800&28040200200801 cITY Everett STATE WA ZIP 98203 SUITE/UNIT#: Building C-D FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Northshore Christian Academy LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Northshore Christian Academy OWNER MAILING ADDRESS: STREET 5700 23rd Drive cIn Everett STATE WA ZIP 98203 OWNER PHONE:425-407-1 1 19 OWNER EMAIL: CONTRACTOR COMPANY NAME:T.B.D. WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET /� Jy ''^� CITY STATE D 2©2�V� CONTRACTOR PHONE: CONTRACTOR EMAIL: 1`rJ IL��' V 1 PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect _ JUL 29 2022 CONTACT NAME: CONTACT PHONE:425-252-2153 Todd Bullock/2812 Architecture CONTACT EMAIL:todd@2812architecture.coPITY OF EVERETT Pcrmit 8crvicoc BUILDING INFORMATION VALUATION OF WORK: $10,000 ASSOCIATED LAND USE PROJECT#(if applicable): (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:Education PROPOSED USE OF BUILDING:Education HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): New Construction ❑Addition ❑Remodel ❑Repair OT.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure El Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Install interior partition to separate existing classrooms at lower floor of Building C. Install exterior door at Classroom C100. Pour new sidewalk from door to existing walk. Install relites in Computer Lab D128 and Library D129. 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Todd Bullock Digitally signed by Todd Bullock 07/20/2022 PERMIT 2 �o Date:20signe Todd 55 hock-07'0 ' [/�'�//+ (rv,L I Owner/Authorized Agent Signature Date I I,_ (Revised 4/21/2022)