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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES MAY <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirem s nd number of1 c iMired f iew, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 320 r S,1 egff 2.0,0 Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425-257-8810 i(E)PermitServices@everettwa.go vdc�ttGra aj/i�e 1ETT <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION PCrmtt services <br /> PROJECT SiTE ADDRESS: STREET 607 Riverside Road PARCEL#: <br /> cny Everett STATE WA zip 98201 <br /> SUITE/UNIT#: NA FLOOR#:NA ADDITIONAL LOCATION INFORMATION (if applicable):NA <br /> TENANT/BUSINESS NAME(if non-residential):Amazon <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: NA Lot No.:NA (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Louie Azwol <br /> OWNER MAILING ADDRESS: STREET 607 Riverside Road <br /> clTy Everett STATE WA zip 98201 <br /> OWNER PHONE:425) 773-1750 OWNER EMAIL: updates@permitflow.com <br /> CONTRACTOR COMPANY NAME:RamJack West <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):RAMJAW*852PW CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): / J 1-t <br /> CONTRACTOR ADDRESS: STREET PO BOX 11701 _ <br /> cliv Eugene STATE OR ZIP 97440 <br /> CONTRACTOR PHONE:848-266-6563 CONTRACTOR EMAIL:updates'@'peTP 'fIOW,Cam(' rfr1ste <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0OTHER(Please Specify)Applicant/AuthorizedPerson (( rAn'IJA .w. ..( --C <br /> CONTACT NAME: CONTACT PHONE:848-266-6563 <br /> Meghann Mingle CONTACT EMAIL:updates@permitflow.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$14,124.09 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 <br /> PROPOSED USE OF BUILDING:NA <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other NA <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.l. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ElTank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ElPool/Hot Tub ❑Tank(above ground) ❑Other:repair of existing slab <br /> DESCRIPTION OF WORK:Voluntary repair of existing slab structure using 4 helical piers. <br /> ACKNOWLEDGEMENT:!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.f am the owner,or!am authorized by the owner of this properly to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18 CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 05/13/2024 PERMIT# <br /> ac4o s -- ©C4C <br /> Owner/Auth ized Agent Signature Date (Revised 4/21/2022) <br />