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BUILDING PERMIT APPLICATION 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 /> 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(VV)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> t <br /> PROJECT SITE ADDRESS: STREET 7/0a Rucker tom PARCEL#: N/A <br /> CITY Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift Statio #2820FLOOR#: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 /> CITY Everett STATE WA ZIP 98204 <br /> OWNER PHONE:425-521-55330 OWNER EMAIL: todd.jacobs@commtrans.org <br /> CONTRACTOR COMPANY NAME: dif- [' ^� (�RQ� /-1,n,,^ <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):(a �\Cg-(-?44i.i- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): f2C'Y f, - <br /> CONTRACTOR ADDRESS: STREET -F- F Qx L x( <br /> CITY �SiF��t�A-fit- STATE w ZIP.� lei 0,27 <br /> CONTRACTOR PHONE: 3'/?. c21(, CONTRACTOR EMAIL: ef2aFfin, <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-521-5330 <br /> Todd Jacobs CONTACT EMAIL:todd.jaCobs@Commtrans.org <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $1 7,500 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: ❑Gas ❑Electric ❑Other N/A <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: RC;ommercial ❑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:Replace windscreens on bus stop platform <br /> DESCRIPTION OF WORK: <br /> Replace old and install new windscreens at Community Transit Swift Blue Line <br /> Bus Station #28 U Located on (Southbound) Rucker Ave. 4 <br /> E-OEIJVE <br /> JAN 29 2f2.4 [(if <br /> CITY OF EVErtETT <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true and correct. Work done pursprprithipegtowipwe with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must tiirsfTie du/Mr/real?,ITAffirfitm 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 Signature Datd (Revised 4/21/2022) <br />