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E BUILDING PERMIT APPLICATION c�� 3 G <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(V1I)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREE ,q (,^.. 6 . Evergreen Way PARCEL#: N/A <br /> crn Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift Statiol�#278 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:4255-521-55330 OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR COMPANY NAME: , ,Q.' <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): Ag C1 I36 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): •�Z �p,�1 / <br /> CONTRACTOR ADDRESS: STREE1 TO U.V.rx1 t00,6 trVt i� �(r�"f <br /> rr ,� CITY 1�r1 STATE �1,7 ZIP -9/312� <br /> CONTRACTOR PHONE: `015—T --001(4 CONTRACTOR EMAIL. • _,,,n fl Ssi A)_,,c- .e, C (,—d <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR ElOTHER(Please Specify) <br /> CONTACT NAME:Todd Jacobs CONTACT PHONE:t42�j-j2 1-rj33O <br /> 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: 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 #2788. Located on (Southbound) Evergreen Way at 4th Ave. W. <br /> o ©I1V1 <br /> . \\ JAN 2 9 2n24 <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done purl �t{gt¢is e�it.rNsf omp wih <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must ,((ire jjut .ru.Vr it ht <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 tPeir rSb.and tjgr�is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. �r vV CCJI <br /> City of Everett Official Use Only <br /> r PERMIT# <br /> 11-' <br /> O�/Aut orized Agent Si ure Date (Revised 4/21/2022) <br /> l <br />