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11 <br /> BUILDING PERMIT APPLICAIAN <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 /> 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 2802 Broadway PARCEL#: 00439166301900 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: 2 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Volunteers of America <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: BLK 663 D-00 Lot No.: 13-26 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:VOA Western Washington Properties Corp <br /> OWNER MAILING ADDRESS: STREET P.O. Box 839 <br /> CITY Everett STATE WA zip 98206 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:CPM K F <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):COMM 19i (1 V 4. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): W 44n 1 <br /> CONTRACTOR ADDRESS: STREET -pO V <br /> CITY S 1 'D l/1 ' 1 ,S STATE 1 r ZIP ?)261 <br /> CONTRACTOR PHONE: 3t00 )l9, (0105 CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-252-2153 <br /> Clinton Johnson, Adam Clark CONTACT EMAIL:clint@2812architecture.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $80,000 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:Business <br /> PROPOSED USE OF BUILDING:Business <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <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.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ERackStorage ❑Pool/Hot Tub ETank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: <br /> Revise interior office area on second floor of existing building and refurbish restrooms. <br /> Area of T.I. = 557 s.f. <br /> RECEOVIED <br /> APR 0 2 2024 <br /> UI I Y VI- tVtt I I <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursua i with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must fir bA ''r the <br /> Building Officia before being a thorized 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, <br /> and I comply th the State C tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ( (26 'kPERMIT# �4 ^ 004- <br /> l ( <br /> Owner thorized Age Signature Date (Revised 4/21/2022) <br />