4027 4TH ST SE 2025-10-06 - Laserfiche WebLink

BUILDING PERMIT APPLICA1 . ..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)Permitservices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4027 4th St.SE PARCEL#: 29052100200100 CITY Everett STATE Washington ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Everett Wastewater Treatment Plant LEGAL DESCRIPTION for new construction: Short PlaVsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Mike Robinson(City of Everett Public Works) OWNER MAILING ADDRESS: STREET 3200 Cedar St CITY Everett STATE Washington ZIP 98201 OWNER PHONE:425-220-6274 OWNER EMAIL: mrobinson@everettwa.gov CONTRACTOR COMPANY NAME:Forma Construction Company WA STATE CONTRACTOR LICENSE#(REQUIRED):FORMACC878OR CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54396 CONTRACTOR ADDRESS: STREET500 Columbia St. NW, Suite 201 CITY Olympia STATE Washington ZIP 98501 CONTRACTOR PHONE.425-248-0544 CONTRACTOR EMAIL:evanm@formacc.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-786-8112 Morgan Salcido CONTACT EMAIL:MorganS@formacc.com BUILDING INFORMATION iu VALUATION OF WORK:$70000 V ASSOCIATED LAND USE PROJECT#(if applicab ): ET (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:No Building in place. Perm► PROPOSED USE OF BUILDING:Temporary Trailer HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ✓❑Accessory Structure TYPE OF PROJECT(check aft that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.l. ❑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: DESCRIPTION OF WORK: Install a temporary job trailer for the lab technicians to utilize as we are replacing the roof on their lab building and hook up power and water to the temporary trailer. 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./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 PERMIT# \I 2, wner/Authorized gent i ature Dale (Revised 412112022)