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• • <br /> 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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1525 75th St SW PARCEL#: N/A <br /> c„-y Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: 100 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable):N/A <br /> TENANT/BUSINESS NAME(if non-residential):CaSCade Coffee <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Warehouse Lot No.:N/A (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Johnson Home& Properties (Scott Johnson) <br /> OWNER MAILING ADDRESS: STREET P 0 Box 13085 <br /> CITY Everett STATE WA ZIP 98206 <br /> OWNER PHONE:425-508-4670 OWNER EMAIL: Scott©fflp.com <br /> CONTRACTOR COMPANY NAME:Northwest Handling Systems <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CC NORTHWH 275JF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 011598 <br /> CONTRACTOR ADDRESS: STREET1100 SW 7th St. <br /> CITY Renton STATE WA zip 98057 <br /> CONTRACTOR PHONE:425-919-3597 CONTRACTOR EMAIL:neilm@nwhs.COm <br /> PRIMARY CONTACT: ❑OWNER _✓i CONTRACTOR n OTHER(Please Specify! Dennis Stickles 425-290-5245 <br /> CONTACT NAME: CONTACT PHONE:425-919-3597 <br /> Dennis Stickles CONTACT EMAIL:neilm@nwhs.corn <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$65,000 ASSOCIATED LAND USE PROJECT#(if applicable):N/A <br /> (Valuation shall include the prevailing fair market value of all iahor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:WarehoUse <br /> PROPOSED USE OF BUILDING:Warehouse <br /> HEAT SOURCE: ❑✓Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ! Multi-Family-#Units._ ❑✓Comrnercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑IAddition !.IPemodel _I Repair LJT.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exter,or A:teration ;_iTank(above ground, L_:Aucessory Structure <br /> ❑Fence over 7ft high ❑RackStcrage ❑PoolrHot Tu`) LiTank(above ground) L✓JOther:vVork Platform <br /> DESCRIPTION OF WORK:Work platform over eauipment. Used to hold roiling hoppers to feed coffee to a <br /> packaging line. <br /> ACKNOWLEDGEMENT:I have reviewed this appication and cnnJrrn tire 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 trio owner,or I am authorzed icy the owne: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 296.20uA WA <br /> City of Everett Official Use Only <br /> /2// Z rPERMIT# <br /> Owner/Authorized Agent Signature e Revised 4/21/2022) <br />