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E <br /> BAILING PERMIT APPLICATI/ IE©E QV rE <br /> CITY OF EVERETT PERMIT SERVICES D <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requireme nd nuNers oVigipiwauired fo• view, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3 edaPerBet FWdritake C ro Box. <br /> CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa. W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION LI I Y OF EVERETT <br /> PROJECT SITE ADDRESS: STREET 3003 West Casino Rd V��� (g- 0—,�,�j PARCEL#: 280410 0 Pq� t s VI(:Cb <br /> � <br /> c Ty Everett STATE Wa ZIP 98204 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential): Boeing <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Boeing Co <br /> OWNER MAILING ADDRESS: STREET 3003 West Casino Rd <br /> cm, Everett STATE WA ZIP 98204 <br /> OWNER PHONE: 425-220-2947 OWNER EMAIL: eric.s.epstein@boeing.com <br /> CONTRACTOR COMPANY NAME:Skanska USA Building Inc. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):SKANSUB985RT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 044389 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE:Jason Floyd CONTRACTOR EMAIL:Jason.floyd@skanska.com <br /> PRIMARY CONTACT: l]OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-220-2947 <br /> Eric S. Epstein CONTACT EMAIL:eric.s.epstein@boeing.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $140,000.00 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:Manufacturing <br /> PROPOSED USE OF BUILDING:Manufacturing <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other <br /> BUILDING TYPE: LISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): EJNew Cullsuucrtien ❑✓Addition ❑Remodel ❑Repair ❑✓T.I. ❑Change of Use <br /> ❑Modular ❑Portable LIRe-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 /> Install a 13 foot (156 inches) long by 28 foot (336 inches) wide by 1 .5 foot (18 inches) <br /> deep exterior concrete foundation and protective bollards for an emergency generator. <br /> Install an interior demising wall, double door, and recessed door opening for a <br /> remodeled electrical room. <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 /> Digitally signed by Eric Epstein, PERMIT# <br /> Eric Epstein, 276672 276672 - <br /> Date:2024.04.15 07:34:56-0700' -_ —✓ ' <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />