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BUILDING PERMIT APPLICATION <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 /> 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 1(E)Permitservices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 14 East Casino Road PARCEL#: 28041300105301 <br /> CITY Everett STATE WA z,P 98208 <br /> SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):The Village <br /> LEGAL DESCRIPTION for new construction: Short Platisubdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Child Strive <br /> OWNER MAILING ADDRESS: STREET 906 SE Everett Mall Way, Suite #200 <br /> c,n Everett STATE WA zIP 98208 <br /> OWNER PHONE:425-353-5656 1OWNER EMAIL: terry.clark@childstrive.org <br /> CONTRACTOR COMPANY NAME:T.@4)T- 5/6-N R-510F S6- ,:�& G <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED)•S/&fV S 80074 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0, Q <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE "44— ZIP <br /> CONTRACTOR PHONE j�� ��� 3 <br /> I CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:425-252-2 1 53 <br /> r Todd Bullock CONTACT EMAIL:todd@2812architecture.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$75", 00 1315, M(7 ASSOCIATED LAND USE PROJECT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,matedals,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING:Offices, Education, Assembly, Day-care <br /> PROPOSED USE OF BUILDING: no Change <br /> HEAT SOURCE: ❑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 ❑PooUHot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:Re-roof the four existing buildings. Changing the roofing materials from concrete the to <br /> standing seam metal roofing. Work includes repairs to roof sheathing as needed. No <br /> changes in the thermal envelope anticipated. <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 Offilcial 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 /> T.g.,216.t�hrized �O Agent Signature Date (Revised 412112022) <br />