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im BUILDING PERMIT APPLICATION I l 'io.Z <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 /> WASH INGTON 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: STREE1 i I L.0 2_ Evergreen Way "ARCEL#: N/A <br /> CITY Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift StationpF1784)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 /> cm, Everett STATE WA ZIP 98204 <br /> OWNER PHONE:425-521-55330 OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR COMPANY NAME: t ,A C-D(5 — �'1 �t�; ��y f <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED)' /iliyj wit CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' 'f P-G=/- <br /> CONTRACTOR ADDRESS: STREET pc) �,,< ( na.6 <br /> CIT( �Ss r STATE ZIP !W02") <br /> CONTRACTOR PHONE l ,C` 3q -�CY6 CONTRACTOR EMAIL '1� 0C4 ci v- "j• .- <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-521-5330 <br /> Todd Jacobs CONTACT EMAIL:todd.jacobs@Ucommtrans.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: ElGas ❑Electric ❑OtherN/A <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: PCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair DTI. ❑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 #2784. Located on southbound SR99 at 112tIrr--S‘t. IN' . w E <br /> uii\ J A N 2 9 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 purRiatgraittpEreFiVikkiarkoly 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 /> ...........___ 16i/1 1/1 ,24=.,A t.P. Z Li 1 lw. y <br /> caner/Authorized Agent Sig re Date (Revised 4/21/2022) <br />