9501 19TH AVE SE BLOOM COFFEE BAR 2025-08-20

BUIL" 'NG PERMIT APPLICATI01 CITY OF EVERETT PERMIT SERVICES i 1 IE C IE O V EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requireme t~S/ d number of copies require eview, WASHINGTON then drop off completed application plus all required submittal documents to 3 Cedar Street 2nd Floor Intake r Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermilServices@everettwa. v (W)e, t4 its (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9501 19th ave se PARCEL#: 2805 0 cin. Everett STATE WA zip 98208 SUITEIUNIT#: NA FLOOR#:NA ADDITIONAL LOCATION INFORMATION (if applicable):NA TENANTIBUSINESS NAME(if non-residential):LEDI Coffee Company, LLC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Ruslan Cherkasskikh OWNER MAILING ADDRESS: STREET 215 196th st sw C1T1, Bothell STATE WA 4p 98012 OWNER PHONE:4253875311 IOWNER EMAIL: russ.cks@gmail.com CONTRACTOR COMPANY NAME:LEDI General Contractor LLC WA STATE CONTRACTOR LICENSE#(REQUIRED,L e-9f(�j'C 77a919 ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62789 CONTRACTOR ADDRESS: STREET215 196th st sw crry Bothell sTATE WA vP 98012 CONTRACTOR PHONE:4253875311 1CONTRACTOR EMAIL:russ.cks@gmail.com PRIMARY CONTACT: 17 OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4253875311 Ruslan Cherkasskikh CONTACT EMAIL:russ.cks@gmail.com BUILDING INFORMATION VALUATION OF WORK: $15000 1ASSOCIATED LAND USE PROJECT# if applicable): (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:Coffee stand PROPOSED USE OF BUILDING:Coffee stand 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 F Remodel ❑Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑✓Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑PoollHot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:Remodel existing coffee stand, Re-roof existing roof, new electrical-(electrical permit submitted), fix drywall after electrical work, replace existing window to new one, new siding, paint interior and exterior. ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein Is true and conect. 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.I am the owner,or I 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# , OwnerlAut orized Agent Signature Date (Revised 412112022)