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BUILDING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 32DO Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 6920 Evergreen Way PARCEL#: 2896993 <br /> crrw Everett STATE WA AP 98203 <br /> SUITEIUNIT#: FLOOR#:1 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANTIBUSINESS NAME(if non-residential).Formally Peoples Bank <br /> LEGAL DESCRIPTION for new construction: Short Platisubdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT.INFORMATION <br /> OWNER NAME:O)son Investment&Management LLC <br /> OWNER MAILING ADDRESS: STREET 6932 Evergreen Way <br /> cny Everett STATE WA nP 98203 <br /> OWNER PHONE:425.418.1519 OWNER EMAIL: Brian@Oimllc.net <br /> CONTRACTOR COMPANY NAME:Gaffney Construction <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):GAFFNC1104K3 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 12160 <br /> CONTRACTOR ADDRESS: s1eer8105 Broadway <br /> crry Everett STATE WA Z,P 98203 <br /> CONTRACTOR PHONE:425.355.5500 1CONTRACTOR EMAIL:JOe@gaffneyconstruction,com <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425,355.5500 <br /> Joe Gaffney CONTACT EMAIL:joe@gaffneyconstruction.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$100,000 ASSOCIATED LAND USE PROJECT# if applicable): <br /> (Valuation shall Include the prevaring lair market vaGTR aA labor,matenals,and equipment needod to complete the work,vehether adually paid or not.) <br /> EXISTING USE OF BUILDING:Peoples Bank <br /> PROPOSED USE OF BUILDING:Thrift Store <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 /> i' ❑Modular ❑Portable [:]Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> f <br /> ❑Fence over 7ft high ❑RackStorage ❑PoollHot Tub ❑Tank(above ground) ❑Other: <br /> d DESCRIPTION OF WORK: <br /> Demolition of non load bearing walls and misc. ceiling, soffit and ACT ceiling repair, <br /> 1 <br /> D #F <br /> JAN 2 2 2024 <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuan �tPP*it&@Pvi " <br /> current federal,slate,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first a authorized in writing from the <br /> Building Ofcial baton being authorized under any circumstance.tam the owner;or l 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 /> i City ofEverett Official Use Only <br /> t � PERMIT <br /> Z <br /> I Ow erfAuthori ed Agent Signature Date (Revised 4/21/2822) <br />