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BUILDING PERMIT APPLICATION <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 (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 906 SE EVERETT MALL WAY, BLD. III PARCEL#: 28051800305401 <br /> cm EVE- STATE WA ZIP 98208 <br /> SUITE/UNIT#: 501 ) ? OOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINES NAME(if non-resident a ERITAGE BANK <br /> LEGAL DESCRIPTION for new construction: Sho --t/subdivisions.- Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:PIETROMONACO JACKSON <br /> OWNER MAILING ADDRESS: STREET 7525 SE 24TH ST, SUITE 300 <br /> clTv MERCER ISLAND STATE WA ZIP 98040 <br /> OWNER PHONE:206-607-6021 OWNER EMAIL: danny@pjpnw.Com <br /> CONTRACTOR COMPANY NAME:TAD k-adWeske -'c <br /> WA STATE CONTRACTOR ICENSE#(REQUI D):V---AcR,k J c Vic(a EVERETT BUSINESS LICENSE#(RECUIRED): 9St-k(/ <br /> CONTRACTOR ADDRESS sTREE <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) ARCHITECT <br /> CONTACT NAME: CONTACT PHONE:206-682-7525 <br /> KE V I N B R O D E R I C K CONTACT EMAIL:kevin@broderickarchitects.Com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:s45,000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> 'Valuation shall include the p(evailinr5 fair market value or all labor materials,and equipment needed to complete the work whether actually paid or not I <br /> EXISTING USE OF BUILDING:B-OFFICE <br /> PROPOSED USE OF BUILDING:NO CHANGE <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: i 1SFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: RlCommercial PlAccessory Structure <br /> TYPE OF PROJECT(check all that apply): Li 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: <br /> INTERIOR OFFICE TENANT IMPROVEMENT ON THE 5TH FLOOR. SCOPE TO <br /> INCLUDE SELECTIVE DEMOLITION OF EXISTING WALLS AND CEILING TILES <br /> AND CONSTRUCTION OF NEW W f,CREATE A wVVLLWAY AND <br /> BREAK ROOM IN SUITE 501. NO E .4RWORK INCL€JDpQ NO CHANGE IN <br /> OCCUPANCY. li <br /> APR 1 6 2024 � <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained hereie�r'�eynrtc��ec rE71CC a Int to this permit must comply with <br /> current federal,state.and local law.The granting of a permit only authorizes approved work and no de to s theref;��mArgrs e first be authorized in writing from the <br /> Building Official before being authorized under any circumstance /am the owner,or/am authorized by th �t }'tAi rm the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 4.10.2024 774 C 0 3 2 <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />