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ri <br />EVERETT <br />WASHINOTON <br />BUILDING PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br />then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-88101 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permlts <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 1730 112th St SW PARCEL M <br />cln. Everett STATE WA zip 98204 <br />SUITEIUNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION (if applicable): Building E <br />TENANT/BUSINESS NAME (if non-residential): Sage Apartments <br />LEGAL DESCRIPTION for new construction: Short PlaUsubdivision: 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 <br />OWNER EMAIL: dan@113mCS.Com <br />CONTRACTOR COMPANY NAME: Camp Construction Services <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): CC CAMPCCS806CD <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET15139 South Post Oak Rd <br />CITy Houston STATE TX Zip 77053 <br />CONTRACTOR PHONE: 503-979-5379 <br />CONTRACTOR EMAIL: dpratt@campconstruction.com <br />PRIMARY CONTACT: ❑ OWNER ❑✓ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />David Pratt <br />CONTACT PHONE:503-979-5379 <br />ICONTACT EMAIL: dpratt@campconstruction.com <br />BUILDING INFORMATION <br />VALUATION OF WORK: $ 25,272.00 ASSOCIATED LAND USE PROJECT # (if applicable): N/A <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actuaity 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: <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. 1 am the owner, or I 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 />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # $ ZZO s o'er <br />(Revised 412112022) �tJ <br />