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1 <br /> ma <br /> LI BQDING PERMIT APPLICAION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 1611 EVERETT AVE PARCEL#: 00562461201800 <br /> CITY EVERETT STATE WA ZIP 98201 <br />' SUITE/UNIT#: FLOOR#: 2 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME (if non-residential):TBD, FNA CLUB BROADWAY <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: RUCKERS FIRST PLAT BLK 612 Lot No.: 18-22 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:BAYSIDE ROLLERS, LLC <br /> OWNER MAILING ADDRESS: STREET 18127 109th AVE SE <br /> CITY SNOHOMISH STATE WA ZIP 9829E <br /> OWNER PHONE:425-312-4049 OWNER EMAIL: JCARLSWELL@NORTHLANDCONTRACTORS.COM <br /> CONTRACTOR COMPANY NAME:NORTHLAND CONTRACTORS <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):NORTHDC900 M CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 53423 QI� <br /> CONTRACTOR ADDRESS: STREET 902 1/2 1st St#201 <br /> CITY SNOHOMISH STATE WA ZIP 98290 <br /> CONTRACTOR PHONE:425-312-4049 CONTRACTOR EMAIL:JCARLSWELL@NORTHLANDCONTRACTORS.COM <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR E OTHER(Please Specify) ARCHITECT <br /> CONTACT NAME: CONTACT PHONE:425-747-3177 <br /> JASON BEAGLE CONTACT EMAIL:JASONB@MLARCH.COM <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $25,000 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:ENTERTAINMENT:THEATER, GALLERY, BAR <br /> PROPOSED USE OF BUILDING:NO CHANGE <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 ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: REMODEL TO ADD NEW ACCESSIBLE RESTROOMS TO AN EXISTING BAR. <br /> CURRENT RESTROOMS ARE NOT ADA COMPLIANT. NO EXTERIOR WORK. NO <br /> ADDITIONAL WORK TO THE BUILDING UNDER THIS PERMIT. MEP PERMITTED <br /> SEPARATELY. <br /> 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 <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.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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 7/1 9/22 pisTi2r),..\ <br /> ---r---0.9-5 <br /> Owner/A thatized Agent Signature Date (Revised 4/21/2022) 1/ <br />