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B•DING PERMIT APPLICA.N ECEIVED <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirement nurrewryf 990 e o� ired ft r v iew, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 32 dar Mgt 2ttd'Fld&'thake D�Box. <br /> CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.go 1 )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#: 102,202,and 302 FLOOR#: 1,2,3 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 B1k 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 /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE:425-355-0353 OWNER EMAIL: ryan@williamsinvest.com <br /> CONTRACTOR COMPANY NAME:JKW General, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):JKWGEGL929O5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 55013 <br /> CONTRACTOR ADDRESS: STREET2517 Colby Avenue <br /> CITY Everett STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:(425) 355 0353 CONTRACTOR EMAIL:ryan@ williamsinvest.com <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Doug Horius,Dykeman Architects <br /> CONTACT NAME: CONTACT PHONE:206 795 2192 <br /> Doug H of i u s CONTACT EMAIL:dough@dykeman.net <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $` Do0 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:Multi-family apartments <br /> PROPOSED USE OF BUILDING:Multi-family apartments <br /> HEAT SOURCE: ❑Gas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units:3 El Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑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:Fire Damage-Demolition <br /> DESCRIPTION OF WORK: Emergency demolition of equipment, specialties, drywall, and finishes, to allow for inspection of building <br /> structure by Architect and Engineer. lation. <br /> Permif 2302-075 was previously issued to cover emergency roofing above these apartments. <br /> Full application for repairs permit to be submitted under separate cover once insurance inspectors have <br /> completed their investigation. <br /> ACKNOWLEDGEMENT:1 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.1 am the owner,or 1 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 /> PERMIT# <br /> LAI O 3 •/g• 2OZ3 Q,:z ASS <br /> Owner/Authorizedlent Signat 4 Date (Revised 4/21/2022) <br />