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BLDING PERMIT APPLICATI•UI <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 /> 40WASHINGTON 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1801 Broadway PARCEL#: 00438236300300) <br /> GUY Everett STATE wa ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Jeff Pat Chris LLC dba Domino's <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:HOSSein Ahmadnia <br /> OWNER MAILING ADDRESS: STREET 8206 2nd Ave NE <br /> CITY Seattle STATE wa DP 98115 <br /> OWNER PHONE:206-235-2111 OWNER EMAIL:hossein_nia@yahoo.com <br /> CONTRACTOR COMPANY NAME: Colt builders inc r1 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CO LTg e L QC10 i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (03 )I <br /> CONTRACTOR ADDRESS: sTREEr14751 S qual grove circle <br /> CITY oregon city STATE oregon ZIP 97045 <br /> CONTRACTOR PHONE:503-504-0697 CONTRACTOR EMAIL:denniSColt@hotmail.com <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 503-504-0697 WjelAvtj L h"lkJ <br /> • Dennis Colt CONTACT EMAIL: <br /> chris.f@jpcpizza.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$75,000 ASSOCIATED LAND USE PROJECT#(if applicable):N/A <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:Closed Wells Fargo Bank <br /> PROPOSED USE OF BUILDING: Remodel into a Domino's Pizza restaraunt <br /> HEAT SOURCE: Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: IZICommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition Remodel ❑Repair ❑T.l. ❑Change of Use <br /> ❑Modular OPortable ORe-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:Demo Interior of old wells fargo. Frame walls, drywall, wall-l:ile, faeer--tile, instaf- <br /> bat t.raam, t 1ple-sink, r tep-sirrk;omens: <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and coned.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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> • PERMIT# <br /> City of Everett Official Use Only <br /> C Panhr-a, 06/6,6/2 t g 2 ( D 5" ( I I-. <br /> Owner/Aurihorized Agent Signature Date (Revised 2J8/2021) <br /> 1/z— <br />