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E BLMING PERMIT APPLICATIOI <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 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 3700 Federal Ave PARCEL#: 00605000500000,29053000302600 <br /> cry Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: P4 FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Everett School District No.2 <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Everett School District No.2 <br /> OWNER MAILING ADDRESS: stii2vcT 3900 Broadway <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE:(425)385-4195 OWNER EMAIL: jcollins@everettsd.org <br /> CONTRACTOR COMPANY NAME:Pacific Mobile Structures, Inc. S1,9%.(AIP• <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):PACIFMS033DC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): F`A84989P288tt <br /> CONTRACTOR ADDRESS: STREET 13806 45th AVE NE <br /> CITY Marysville STATE WA ZIP 98271 <br /> CONTRACTOR PHONE:(360)345-1577 CONTRACTOR EMAIL:bobbie.leneker@pacificmobile.com <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑✓ OTHER(Please Specify) Architect <br /> CONTACT NAME: Zach Ham CONTACT PHONE:(425)609-2315 <br /> CONTACT EMAIL:ZachH@dykeman.net <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $9,615.44 ASSOCIATED LAND USE PROJECT#(if applicable): <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:E-Educational <br /> PROPOSED USE OF BUILDING:E-Educational <br /> HEAT SOURCE: EGas ❑✓Electric DOther <br /> BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition DRemodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑✓Portable ❑Re-roof DExterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> DFence over 7ft high ❑RackStorage DPool/Hot Tub ❑Tank(above ground) DOther: <br /> DESCRIPTION OF WORK:Existing P4 portable to be relocated within Jackson Elementary site with applicable site <br /> work including foundation pad, welcome ramp, and landi Ecislly <br /> -� <br /> FEB 17 2024 EJ <br /> rayOF EVERETT <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done Pur l Sartbftf ee&ompiy 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 /> ate (Revised 4/21/2022) <br /> 0 r u Id Agent Si nature <br />