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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> 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)PermilServices@everettwa.gov I(W)everettwa.gov/pennits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1730 112th St.SW PARCEL M 00537900004100 <br /> clTv Everett STATE WA ZIP 98204 <br /> SUITEIUNIT#: ' FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): All aldgsA,H,c,D,E,F,G,H, <br /> TENANT/BUSINESS NAME(if non-residential):Sage Apartments <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Existing Multi Family Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:L13 MCS South, LLC <br /> OWNER MAILING ADDRESS: STREET 2111 152nd Ct, E. <br /> ,IT,, Bradenton STATE FL ZIP 34212 <br /> OWNER PHONE:508-864-6140 OWNER EMAIL: dan@I13mcS.COm <br /> CONTRACTOR COMPANY NAME: Camp Construction Services <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CC CAMPCCS806CD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 64610 <br /> CONTRACTOR ADDRESS: STREET 15139 South Post Oak Rd <br /> clTy Houston STATE TX ZIP 77053 <br /> CONTRACTOR PHONE: 425-362-0413 1CONTRACTOR EMAIL: henryyoun@gmall.Com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-362-0413 <br /> Henry Youn CONTACT EMAIL: henryyoun@gmail.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$30 00.00 ASSOCIATED LAND USE PROJECT#(if applicable): N/A <br /> (Valuation shall include the prevailir4fair market value of all labor,materials,and equipment needed to complete the work,%uhelher actually paid or not.) <br /> EXISTING USE OF BUILDING: Multi-Family <br /> PROPOSED USE OF BUILDING: Multi-Family <br /> HEAT SOURCE: []Gas ❑✓Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units: ❑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: <br /> DESCRIPTION OF WORK: Remove and dispose of existing comp - shingle roofing and replace with new comp - <br /> shingle roofing. Like for like replacement. <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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 654a2061-586a-4a3a- Digitally signed by PERMIT# <br /> 9791-85942b7d7460 6ate:202 .08.2408:13:21-07'00' 7d7460 08/27/2024 uu <br /> Dale:2024.08.27 08:13:26-07'00' �' " <br /> Owner/Authorized Agent Signature n�" 1 Dale (Revised 412112022) <br />