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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EV E R E T T 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 submlttal 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 M <br /> ciTy Everett STATE WA 98204 <br /> SUITElUNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): Clubhouse <br /> TENANT/BUSINESS NAME(if non-residential):Sage Apartments <br /> LEGAL DESCRIPTION for new construction: Short Plattsubdivision: 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 /> clTr Bradenton STATE FL 21P 34212 <br /> OWNER PHONE:508-864-6140 OWNER EMAIL: dan@113mcS.Com <br /> CONTRACTOR COMPANY NAME:Camp Construction Services <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CC CAMPCCS806CD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET 15139 South Post Oak Rd <br /> crry Houston STATE TX zip 77053 <br /> CONTRACTOR PHONE:503-979-5379 CONTRACTOR EMAIL:dpratt@campconstruction.com <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:503-979-5379 <br /> David Pratt CONTACT EMAIL;dpratt@campeonstruction.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $11,856.00 ASSOCIATED LAND USE PROJECT#(if a plicable):N/A <br /> (Valuation shall Inctude the prevailing fair market value or 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 /> BEAT 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 ZRe-roof ❑Exterlor Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7fl 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 frue 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 /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />