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BL .DING PERMIT APPLICAT N <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 F or Intake Drop Box. <br /> CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.go permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 200 W Marine View Drive PARCEL#: <br /> CITY Everett STATE WA Zip 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION ' applicable): <br /> TENANT/BUSINESS NAME(if non-residential):onTrac <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Baywood Industrial LLC, attn Dave Kessler <br /> OWNER MAILING ADDRESS: STREET PO Box 817 <br /> CITY Auburn STATE WA Zip 98071 <br /> OWNER PHONE: OWNER E ' IL: dave@latitudedev.com <br /> CONTRACTOR COMPANY NAME:TBD <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Applicant <br /> CONTACT NAME: CONTACT PHONE:630-796-0557 <br /> Erin Vickrey CONTACT EMAIL:evickrey@scoutservices.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$3,000,000 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market valu of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:ware rouse <br /> PROPOSED USE OF BUILDING: arehouse <br /> HEAT SOURCE: ❑Gas • lectric ❑Other <br /> BUILDING TYPE: ❑SFR ETownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(ch•ck all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair OT.I. ❑Change of Use <br /> ❑Modular ❑Port.ale ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft •igh ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Conveyor installation <br /> DESCRIPTION •F WORK: <br /> Commercial conveyor installation inside an existing commercial space <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit 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 /> PERMIT# <br /> Owner/Authorized Agent Signa re Date (Revised 4/21/2022) <br /> /I.( <br />