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ti <br /> BOLDING PERMIT APPLICA.N <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 1030 Ttereve Drive,Everett,WA PARCEL#: 00392800600100 <br /> CITY Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: Roof over unit 302 FLOOR#: 3 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Marie Anne Apartments <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Beverly Hills Div.1 Blk 006 Lot No.: 1&2 Block 6 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:GJJ Williams Investments LLC <br /> OWNER MAILING ADDRESS: STREET 2517 Colby Avenue <br /> C1rr Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-355-0353 0 NER EMAIL: ryan@williamsinvest.com <br /> CONTRACTOR COMPANY NAME:Superior Line Roofing, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):SUPERLR857JO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54877 <br /> CONTRACTOR ADDRESS: STREET PO Box 12292 <br /> c!Ty Everett STATE WA ZIP 98206 <br /> CONTRACTOR PHONE:(425)268 6720 CONTRACTOR EMAIL:info@superiorlineroofing.com <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Doug Hofius,Dykeman Architects <br /> CONTACT NAME: CONTACT PHONE:206 795 2192 <br /> Doug Hofius <br /> CONTACT EMAIL:dough@dykeman.net <br /> BUILDING INFORMATION <br /> VALUATION OF K: $5,000 \ ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include e prevailing fair mark value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF UILDING:Mu i-family apartments <br /> PROPOSED USE 0 BUILDIN .Multi-family apartments <br /> HEAT SOURCE: ❑ ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ✓❑Multi-Family-#Units:3 ❑Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable III Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Fire Damage <br /> DESCRIPTION OF WORK: Emergency re-roof to cover limited demolition as necessary, with roof deck, and underlayment <br /> installation. <br /> This portion of the work is requested as emergency work to avoid further weather damage over the <br /> winter. <br /> Full application for repairs permit to be submitted under separate cover once insurance inspectors have <br /> completed their investigation. <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 /> tAlr) <br /> PZi)3UZ <br /> 2- • «-• 2c7.2 <br /> Owner/Authorized ent Signatu Date (Revised 4/21/2022) <br />