11131 EVERGREEN WAY SWIFT 2025-04-29

in BUILDING PERMIT APPLICATION { it CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I(VV)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ///I rEvergreen Wa .PARCEL#: N/A Ty Everett STATE WA ZIP 98204 SUITE/UNIT#: Swift Station 2783 LOOR#:N/A ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Community Transit LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Todd Jacobs(Community Transit) OWNER MAILING ADDRESS: STREET 2312 W. Casino Road cm, Everett STATE WA zip 98204 OWNER PHONE:425-521-55330 OWNER EMAIL: todd.jacobs@commtrans.org commtrans.org CONTRACTOR COMPANY NAME: c' A- (4(Z2y 4V WA STATE CONTRACTOR LICENSE#(REQUIRED)ek ttC 1 4f1`CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)_ aW�Y�ftidl' CONTRACTOR ADDRESS: STREET 4O. O)C (OO6 CITY ..S-cl-QU, '" STATE 1061,4 ZIP 9 ? CONTRACTOR PHONE: Lt ,$'- Z,,80/ CONTRACTOR EMAIL C*',/JC,5J� }e-4 .4�C PRIMARY CONTACT: El OWNER El CONTRACTOR El OTHER(Please Specify) .7 CONTACT NAME:Todd Jacobs CONTACT PHONE:425-521-5330 CONTACT EMAIL:toddjacobs@commtrans.org BUILDING INFORMATION VALUATION OF WORK:$17,500 ASSOCIATED LAND USE PROJECT#(if applicable):N/A (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:Bus Station PROPOSED USE OF BUILDING:Bus Station HEAT SOURCE: ❑Gas ❑Electric ❑OtherN/A BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: 04nmercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ETA. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Replace windscreens on bus stop platform DESCRIPTION OF WORK: Replace old and Install new windscreens at Community Transit Swift Blue Line Bus Station #2783. Located on northbound SR99 at 112th St. SW glECEOVE JAN 29 ?f124 ' ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work do isbanTio'thii^pe5vrtit 'cJm ly with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations m $r(sr u jleg i(rmih g from the 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 app ication is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 4l �G� - Li •zozy PERMIT# ' >'J 6�L10( — 063 r u orized Agent Sig re Date (Revised 4/21/2022)