11419 19TH AVE SE KUMON AFTER SCHOOL CRTR 2023-04-07

BUILDING PERMIT APPLICATI•ON 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 11419 19TH AVE. PARCEL#: 011055-000-001-01 cm( EVERETT STATE WA. ZIP 98208 SUITE/UNIT#: 105 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):KUMON AFTER-SCHOOL CENTER LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Ly Lim OWNER MAILING ADDRESS: STREET 3729 169th PI SE CITY BOTHELL STATE WA. ZIP 98012 OWNER PHONE:610.504.5077 OWNER EMAIL: ISM 05©hotmail.com CONTRACTOR COMPANY NAME:TBD TC7 1 R Win 0� � rY�(-1 WA STATE CONTRACTOR LICENSE#(REQUIRED):70 P.R/�/(i( R G VAN)/CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):f t Lt.1 pi LZ CONTRACTOR ADDRESS: STREET Z 5 9 Z 4 / 8 4yt S '^, G� 1 CITY /�t STATE I �'4 ZIP / g0 CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 7 OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425.317.8017 Sandra Higgins CONTACT EMAIL:sandra@caparchgroup.com 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: Group B PROPOSED USE OF BUILDING: Group B HEAT SOURCE: EGas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse EDuplex ❑ADU ❑Multi-Family-#Units: Commercial EAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction EAddition ❑Remodel ❑Repair OT.I. ❑Change of Use EModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure EFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Add interior non-load-bearing walls to create a Waiting Area and one Office; relocate existing door to toilet room and wall infill at existing opening. 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 com ly with the.State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 6_ 8/03/22 P IT# Owner/Authorized Agent Signature' Date (Revised 4/21/2022)