2821 HOYT AVE 2025-10-03 - Laserfiche WebLink

boll-DING PERMIT APPLICATION 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREEt2,05 qoyt Avenue PARCEL#: N/A CITY EV ttP)m STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):City Of Everett LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:City of Everett OWNER MAILING ADDRESS: STREET 2930 Wetmore Avenue CITY Everett STATE WA Zip 98201 OWNER PHONE:425.257.6294 OWNER EMAIL:jolsen@everettwa.gov CONTRACTOR COMPANY NAME:Forma Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):FORMACC878OR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54396 CONTRACTOR ADDRESS: STREETS 016 1 St Avenue S., Suite 400 CITY Seattle STATE WA Zip 98134 CONTRACTOR PHONE:2066260256 1CONTRACTOR EMAIL:Jesse.Tax@formacc.com PRIMARY CONTACT: El OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.257.6294 Joan Olsen, Project Coordinator CONTACT EMAIL:jolsen@everettwa.gov BUILDING INFORMATION VALUATION OF WORK: $25, e7a . 0 0 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevalliKfair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: City of Everett Right of Way-Sidewalk& Parking Lane PROPOSED USE OF BUILDING:Sidewalk Restroom 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 El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK: Site work including electrical, plumbing and sewer to install a prefabricated Sidewaaa Restroom in the public right of way adjacent to Everpark Gara e. E�V D � APR 12 2024 „„�� pV�(EJRETT ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to tll?�FrhkMhfis�n yt 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 1 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 04/10/2024 PERMIT# Ea , f �� Owner/ ut orized Agent Signature Date (Revised 412112022) u