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P"'LDING PERMIT APPLICA' =')N 2 <br /> CITY OF EVERETT PERMIT SERVICES i I ) r !� U� <br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements aA-M number of copies requir r 'ew, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 320d l3edar t et 2nd Floor Intake DI-p ox. <br /> CONTACT INFORMATION: (P)425-257-8810 1 (E)PermitServices@everettwa.go�"I'W)e I, a3#/ s <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 3315 SeawayBlvd. Q G PARCEL#: - r`77 77 1 <br /> 28040300�p0300.._.; ,- <br /> CITY Everett STATE WA Zipv98203 <br /> SUITE/UNIT#: 130 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):magniX <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:C/O JSH Properties Inc. <br /> OWNER MAILING ADDRESS: STREET 14900 Interurban Ave S#130 <br /> CITY Seattle STATE WA ZIP 98168 <br /> OWNER PHONE:310.985.0062 OWNER EMAIL: kevink@jshproperties.com <br /> CONTRACTOR COMPANY NAME: �f'r (,J <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 ❑.r OTHER(Please Specify) Installation Fabricator <br /> CONTACT NAME: CONTACT PHONE:310.985.0062 <br /> DCE USA, CONTACT:JORGE DA ROSA) CONTACT EMAIL:JDAROSA@DCE-USA.COM <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $45,000 ASSOCIATED LAND USE PROJECT#(if applicable):NA <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:F-1 <br /> PROPOSED USE OF BUILDING:NO CHANGE <br /> HEAT SOURCE: 0✓Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑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: <br /> DESCRIPTION OF WORK: Interior tenant improvement for placement of free standing office, conference, and <br /> storage space installed by exhibits manufacturer, DCE USA ( CONTACT: JORGE DA <br /> ROSA, JDAROSA@DCE-USA.COM, (310) 985-0062 ). Mechanical, electrical, and fire <br /> protection permit and design by other under separate permit. <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 Offcial before being thorized 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 Stat tracto Law 18.27 CW and 296.200A WAC. <br /> (j7 City of Everett Official Use Only <br /> PERMIT# <br /> r 7 <br /> ��>P 3. f � <br /> Owner/Authorize gent Si ature Date (Revised 412112022) <br />