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in BUILDING PERMIT APPLICATION /(o as <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 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov I ON)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET Pacific Ave. PARCEL#: N/A <br /> C1ry Everett STATE WA ZIP 98204 <br /> SUITE/UNIT#: Swift Stationf#2835 FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Community Transit <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: N/A Lot No.: N/A (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Todd Jacobs (Community Transit) <br /> OWNER MAILING ADDRESS: STREET 2312 W. Casino Road <br /> CITY Everett STATE WA Zip 98204 <br /> OWNER PHONE:425-521-5330 OWNER EMAIL: todd.jaCobs commtrans.org <br /> CONTRACTOR COMPANY NAME C. '1 C A7,2. ry/ 1�C{�� _ / " <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): (31tC { 4— CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): /� ?r /,f <br /> CONTRACTOR ADDRESS: STREET 'Po, /� �1 0�06 <br /> / CITY '*�'�55��'ay.A-1�' STATE (AM ZIP ��0� <br /> CONTRACTOR PHONE: 4 3 , 13O0 CONTRACTOR EMAIL �r2(S Q G; c-cliA-- <br /> PRIMARY CONTACT: El OWNER ❑CONTRACTOR L 1 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-521-5330 <br /> Todd Jacobs CONTACT EMAIL:todd.jacobs@commtrans.org <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $1 7,500 ASSOCIATED LAND USE PROJECT#(if applicable):N/A <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:BUS Station <br /> PROPOSED USE OF BUILDING:BUS Station <br /> HEAT SOURCE: EGas ❑Electric ❑Other N/A <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Lommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> EFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Replace windscreens on bus stop platform <br /> DESCRIPTION OF WORK: <br /> Replace old and install new windscreens at Community Transit Swift Blue Line <br /> Bus Station #2835. Located on (Eastbound) Pacific Ave. at Wetmore Ave. <br /> Ei ECIEUVE 'N't <br /> JAN 29 202'i J <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 metl fi� e orEV ERrETTthe <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perforrige�,l irtc fos gipvippl cc t on is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 111t J@ I(. <br /> City of Everett Official Use Only <br /> ��� „_ PERMIT# \ O p — 0 eLt <br /> OwrtAut orized Agent Sign u/e Date (Revised 4/21/2022) <br /> l/ <br />