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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 1730 112th St SW PARCEL#: <br /> clTv Everett STATE WA zp 98204 <br /> SU1TElUNIT M FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Building A <br /> TENANTIBUSINESS NAME(if non-residential):Sage Apartments <br /> LEGAL DESCRIPTION for new construction: Short Platfsubdivislon: Existing Multi Family Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:L13 MCS South, LLC (Owner Contact Dan Ricci) <br /> OWNER MAILING ADDRESS: STREET 2111 152nd Ct E. <br /> CITY Bradenton STATE FL zip 34212 <br /> OWNER PHONE:508-864-6140 OWNER EMAIL: dan@113mes,com <br /> CONTRACTOR COMPANY NAME:Camp Construction Services <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CC CAMP CCS806CD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 15139 South Post Oak Rd <br /> clTy Houston STATE TX zIa 77053 <br /> CONTRACTOR PHONE:503-979-5379 CONTRACTOR EMAIL:dpratt@campconstruction.com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:503-979-5379 <br /> David Pratt CONTACT EMAIL:dpratt@campconstruction.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$25,896.00 ASSOCIATED LAND USE PROJECT#(if applicable):NIA <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 <br /> PROPOSED USE OF BUILDING:Multi-Family <br /> HEAT SOURCE: []Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Famlly-#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 ZRe-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 /> Remove and dispose of existing comp-shingle roofing and replace with new <br /> comp-shingle roofing. Like for like. <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 f8.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# 6 n 2-K-0�6 <br /> OwnerfAuthorized Agent Signature Date (Revised 412112022) (� <br />