620 10TH ST 2023-06-22 - Laserfiche WebLink

BLDING PERMIT APPLICATION EVERETT CITY EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicableOF 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)425.257.88101(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 620 10th Street PARCEL#: 29051800204000 Cm( Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Port of Everett OWNER MAILING ADDRESS: STREET 1205 Craftsman Way, Suite 200 CITY Everett STATE WA zip 98201 OWNER PHONE:425-259-3164 OWNER EMAIL: N/A CONTRACTOR COMPANY NAME:FORMA Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):FORMACC878OR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54396 CONTRACTOR ADDRESS: STREET 1016 1st Ave S#400 CI Ty Seattle STATE WA ZIP 98134 CONTRACTOR PHONE:N/A CONTRACTOR EMAIL:N/A PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-508-6627 Brandon \/Vh I to ke r CONTACT EMAIL:bwhitaker@portofeverett.com BUILDING INFORMATION VALUATION OF WORK: $$1,100,000 ASSOCIATED LAND USE PROJECT#(if applicable):Shoreline Permit#SMA20-007 (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:Public Restroom PROPOSED USE OF BUILDING:Public Restroom HEAT SOURCE: ❑Gas ©Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi Family-#Units: 1Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use VModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: The scope of the project includes demolishing an old restroom building (D2105-028) and replacing with a new restroom facility with foundation. The project also includes replacing surrounding hard scape to facilitate ADA access. ACKNOWLEDGEMENT 1 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 "R-r"olft 2/10/22 PST#��'' O —0 21 Rom. Eveerw- �=�'� Owner/Authorized Agent Signature Date (Revised 2/8/2021)