10521 19TH AVE SE EDWARD JONES 2025-10-27

Bl DING PERMIT APPLICAT__V CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable 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) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits (Blue orl' iack Ink Only Please : PROJECTSITE INFORMATION PROJECT SITE ADDRESS: STREET 10521 19th Ave SE PARCEL #: CITY Everett STATE Washington ZIP 98208 SUITE/UNIT : 101 FLOOR M 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/B SS NAME (if non-residential): Edward Jones LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION .. OWNER NAME: David Miller OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE:4255-586-55633 OWNER EMAIL: dmlller@nal-psp.com CONTRACTOR COMPANY NA o Be Determined �'' ST W vts�-hiuh IT/ 1 WA STATE CONTRACTOR LICENSE #(REQUIRED): HST COUT11 0 ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) Applicat, Architect CONTACT NAME: Michael Lombardo CONTACT PHONE:314-242-'1379 CONTACT EMAIL:michael.lombardo@thelawrencegroup.com BUILDING INFORMATION VALUATION OF WOR . $77- s_ D MD 1ASSOCIATED LAND USE PROJECT # (if applicable): (Valuation shall include the pr vailing fair market valu of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) EXISTING USE OF B LDING.g mercial, Business PROPOSED USE OF BUILDING: Commercial, Business HEAT SOURCE: ❑Gas ❑✓ Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: []Commercial ❑Accessory Structure TYPE OF PROJECT (check all that apply) : ❑New Construction ❑Addition ❑Remodel ❑Repair ✓❑T.I. ❑Change of Use ❑Modular ❑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: Interior tenant improvement of shell space. Infill slab leave -out, new partitions, doors, furniture, fixtures, finishes, electrical devices, equipment, ceiling grid, lighting, mechanical ductwork and diffusers, plumbing fixture for breakreMrW!aAities are located in common building areas. D APR 2 2 2024 c;IrvQ� ACKNOWLEDGEMENT.' 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pu(�uant o �jis �i�i s� mTly with current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations m' t r0rs��At a&V1b 0®g from the Building Official before being authorized under any circumstance. 1 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. Agent Signature 04/12/2024 Date City of Everett Official Use Only PER # 2Lk0 - cqq (Revised 412112022)