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BUILONG PERMIT APPLICATIO• <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 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 8530 Evergreen Way PARCEL#: <br /> CITY Everett STATE WA zip 98204 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): Fred Meyer#95 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fred Meyer Stores/John Pioshay <br /> OWNER MAILING ADDRESS: STREET 3800 SE 22nd Ave. <br /> CITY Portland STATE OR ZIP 97202 <br /> OWNER PHONE: 503-797-3967 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: Gorman Roofing Services, Inc. <br /> INA STATE CONTRACTOR LICENSE#(REQUIRED): GORMARS983LL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 41578 <br /> CONTRACTOR ADDRESS: STREET 2229 E University Dr. <br /> CITY Phoenix STATE AZ ZIP 85034 <br /> CONTRACTOR PHONE: 602-262-2423 CONTRACTOR EMAIL: barrym@gormanroofing.com <br /> PRIMARY CONTACT: 0 OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 642-558_2886 (cell) <br /> Barry Moore CONTACT EMAIL: barrym@gormanrofing.com <br /> BUILDING INFORMATION <br /> /ALUATION OF WORK: $ 2,823,315.00 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: Commercial Retail <br /> 'ROPOSED USE OF BUILDING: Same <br /> 'EAT SOURCE: ❑Gas ❑Electric ❑Other <br /> 3UILDING TYPE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> 'YPE 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 EPool/Hot Tub ❑Tank(above ground) ❑Other: <br /> )ESCRIPTION OF WORK: Tear off existing roofing system. Replace with 2 layers 3.1" polyiso, .5" coverboard, <br /> and 60 mil TPO membrane. Replace all sheet metal with new. <br /> CKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> urrent 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 /> uilding Official before being authorized under any circ stance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> nd 1 comply with the State Contractors La . ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> d'EAN) 1\1\ �42— �J Z�f z # <br /> �- PERMIT 3 zz�y—Doi <br /> .weer/Authorized Agent Signature Da (Revised 4/21/2022) 1� <br />