9910 EVERGREEN WAY BUZZ INN STEAKHOUSE 2025-09-11

13L. _DING PERMIT APPLICATIL A CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425.257.8810 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9910 EVERGREEN WAY PARCEL#: 28041300302700 CITY EVERETT STATE WA ZIP 98204 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):BUZZ INN STEAKHOUSE LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME.ROBINSQN Fo"nu v r�TRUST w 0,a .pry- ` L Itt OWNER MAILING ADDRESS: STREET 18690 STATE ROUTE 2,STE. 146 CITY MONROE STATE WA ZIP 9e272 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): �)` gi, I OF EVERETT BUSINESS LICENSE#(REQUIRED): 52_ CONTRACTOR ADDRESS: sTUE�r C ITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) APPLICANT CONTACT NAME: CONTACT PHONE:971.979.0075 Brandon Clower CONTACT EMAIL:bclower@capitaidesignservices.com BUILDING INFORMATION VALUATION OF WORK:$45000 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING:Restaurant PROPOSED USE OF BUILDING:N/A HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑✓Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration []Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Eligible Facilities Request Modification DESCRIPTION OF WORK: Eligible Facilities Request for the installation of (3) new antennas with ancillary equipment on an existing monopole, and associated ground equipment within an existing fenced compound to be expanded by 25 SF. An 8'-0" tower extension is also proposed. 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only — . PE v14 08-05-22 ne rized Signature Date (Revised 21812021)