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--yw o <br /> ..... <br /> 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 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 L l l a Evergreen Wa, PARCEL#: N/A <br /> 0r Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift Station 2796 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 p©commtrans.Org <br /> CONTRACTOR COMPANY NAME: a j_�_' .Qf� ,, . <br /> WA STATE CONTRACTOR LICENSE#(REQUIREL�. 2 ._..4 C., CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �, I9 <br /> CONTRACTOR ADDRESS: STRI <br /> CITY qZ, c4 /4 H STATE 44f.eft ZIP rn' I <br /> CONTRACTOR PHONE' ` 95----3'V -4BOf6 CONTRACTOR EMAIL: 1(,$J &G464S' & 6:0Gc...-1 <br /> J <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-521-5330 <br /> Todd Jacobs CONTACT EmAiLtodd.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: ommercial ❑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:Replace windscreens on bus stop platform <br /> DESCRIPTION OF WORK: Replace old and Install new windscreens at Community Transit Swift Blue Line <br /> Bus Station #2796. Located on (Southbound) EvergI <br /> nn <br /> JAN 29 2024 <br /> (ITV OF EVERETT <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct WorPc�f 114&jSer/Vie rS 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 /> ----A +,�/ 7 ,. -a Y. -z z di PERMIT# <br /> 'C ® I ---0 SS <br /> owe/Authorized Agent Si natpre Date (Revised 4/21/2022) <br /> .. <br />