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4 <br /> E B9LDING PERMIT APPLICATI N <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)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 5700 23rd Drive PARCEL#: 28040200200800&28040200200801 <br /> CITY Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Northshore Christian Academy <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Northshore Christian Academy <br /> OWNER MAILING ADDRESS: STREET 5700 23rd Drive <br /> cITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE:425-407-1 1 19 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:T.B.D. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:425-252-2153 <br /> Todd Bullock/2812 Architecture CONTACT EMAIL:todd@2812architecture.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$15,000 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:EdUcational <br /> PROPOSED USE OF BUILDING:Educational <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse Duplex EADU ❑Multi-Family-#Units: OCommercial EAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair OT.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:Install interior partition to separate existing classrooms in walkout basement of Bldg C. <br /> Install exterior door at Classroom C100. Pour new sidewalk from door to existing walk. <br /> Install relites in Computer Lab D128 and Library D129. <br /> Create new office by installing partitions and a door in corridor of building B, first floor. <br /> 9 <br /> W.... <br /> ACKNOWLEDGEMENT 1 have reviewed this application and confirm the information contained herein is true nd 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7 ' /0g41 07/07/2022 PE AV # (.54 <br /> q______ <br /> lip <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br /> 2 i 2._ <br />