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NNE <br /> in BUILDING PERMIT APPLICATION 0 0 2- <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 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 50 C z; Evergreen Way PARCEL#: N/A <br /> CITY Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift Station 2816 FLOOR#:N/A ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):COmmUnity Transit <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Todd Jacobs(Community Transit) <br /> OWNER MAILING ADDRESS: STREET 2312 W. Casino Road <br /> CITY Everett STATE WA ZIP 98204 <br /> OWNER PHONE:425-521-55330 ` OWNER EMAIL: todd.jacobs@commtrans.org ��J <br /> CONTRACTOR COMPANY NAME Ci4 c_Ace .t) t-tl�� ao:w <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): 4 C.14(1 M ITY OF EVERETT BUSINESS LICENSE#(REQUIRED):G l.E"yl/ T <br /> CONTRACTOR ADDRESS: STREET 2P$0 „..C.x /006 <br /> CITY ,..5,-4'( STATE w/�/"' ZIP 6)&2) <br /> CONTRACTOR PHONE S --3%J'"bgi6 CONTRACTOR EMAIL: f1.at4j c re,P ear-,_. <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-521-5330 <br /> Todd Jacobs CONTACT EMAIL:todd.jacobs@commtrans.org <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $17,500 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 actually paid or not.) <br /> EXISTING USE OF BUILDING:BUS Station <br /> PROPOSED USE OF BUILDING:Bus Station <br /> HEAT SOURCE: ❑Gas ❑Electric ❑Other N/A <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Ltc:ommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ETA. ❑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:Replace windscreens on bus stop platform <br /> DESCRIPTION OF WORK: <br /> Replace old and install new windscreens at Community Transit Swift Blue Line <br /> Bus Station #2816. Located on (Southbound) Evergreen Ile <br /> k['WE <br /> J A N 29 2024 J <br /> CITY OF EVERETT <br /> ACKNOWLEDGEMENT I have reviewed this application and confirm the information contained herein is true and correct.Work done pursn. b� A ¢ toy with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must t r' PnY,F m 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 /> ftil �—^ l'l F.) <br /> City of Everett Off�iciial Use <br /> 7Only �j C��i7 . .--kCA,N ZY. 202�f PERMIT# lv 1 Li L' <br /> O�awef/AA orized Agent Signatur Date c (Revised 4/21/2022) <br />