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�0 <br />UILDING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.88101 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 10330 EVERGREEN WAY PARCEL #: 00535200001400 <br />CITY EVERETT STATE WA ZIP 98204 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): <br />TENANT/BUSINESS NAME (if non-residential): GLINT CAR WASH <br />LEGAL DESCRIPTION for new construction: Short Plat/subdivision: LOT I of EVERETT BSA REC 8802080174 Lot No.: EX PARCEL B' (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: SERJ DEVELOPMENTS, LLC <br />OWNER MAILING ADDRESS: STREET 1500 EAST KATELLA AVENUE #5 <br />CITY ORANGE STATE CA ZIP 92867 <br />OWNER PHONE: (425) 577-8556 <br />OWNER EMAIL: runeh@kiddermathews.com <br />CONTRACTOR COMPANY NAM E:.TO.BE.DET.F-RMINEfl <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />PITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) ARCHITECT <br />CONTACT NAME: <br />E R I C KOC H <br />CONTACT PHONE: (425) 636-8006 x105 <br />CONTACT EMAIL: eric@padgi.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 250,000 <br />ASSOCIATED LAND USE PROJECT # (if applicable): Klein-SERJ BSP20-005 <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: NA <br />PROPOSED USE OF BUILDING: CAR WASH <br />HEAT SOURCE: ❑✓ Gas ❑Electric ❑Other <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: [Z]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. Construct Tenant Improvement for new Glint Car Wash. Drawings include MEP and all <br />car wash equipment. <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. / am the owner. or l am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Ern. Kwh = --- 9/10/2021 <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 21812021) <br />�I <br />