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1 ©1v <br /> L: BLDING PERMIT APPLICAT IA JUL 03 2023 <br /> EVERETT <br /> CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements a o <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Ced �tf fit Drop Box. <br /> CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)eve ee'fe is go �'Drop Box. <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 7601 EVERGREEN WAY <br /> PARCEL#: <br /> cim, EVERETT <br /> STATE WA ZIP 9820: <br /> SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):US BANK <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: <br /> Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Safeway Inc <br /> OWNER MAILING ADDRESS: STREET 1000 124th Ave NE <br /> crry Bellevue STATE WA <br /> ZIP 98015 <br /> OWNER PHONE:(425)_455-8688 !OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:INCLIGN LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):INCLIL`835M4 <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62138 <br /> CONTRACTOR ADDRESS: STREET2516 MARINE VIEW DR <br /> ciTy EVERETT <br /> STATE WA ZIP 98201 <br /> CONTRACTOR PHONE:262-583-7999 (CONTRACTOR EMAIL:MICHAEL@INCLIGN.COM <br /> PRIMARY CONTACT: ❑OWNER E✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:262-583-7999 <br /> MICHAEL RO D R I G U EZ CONTACT EMAIL:MICHAEL@INCLIGN.COM <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$2500 'ASSOCIATED LAND USE PROJECT#(if applicable): <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:US BANK <br /> PROPOSED USE OF BUILDING:Storage <br /> HEAT SOURCE: ❑Gas ❑Electric QOtherHVAC no changes to existing <br /> BUILDING TYPE: ❑SFR ETownhouse ElDuplex ❑ADU ❑Multi-Family-#Units: <br /> Commercial EAccessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair CT.l. ❑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: <br /> DESCRIPTION OF WORK:Remove interior nonbearing interior walls, <br /> removewallsACT, DW patch and finish original peremeter othen painffice t Remove and Replace <br /> White boxing area that used to be US Bank. <br /> 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 <br /> 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 <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 1 comply with the State contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#—> <br /> /7 - 009- I <br /> O n / uthorized gent ignature <br /> Date (Revised 4/21/2022) <br />