5700 23RD DR W BLDG B 2022 2025-11-07

B' `'LDING PERMIT APPLICAT-7N 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 i(E)PerrnitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5700 23rd Drive PARCEL#: 28040200200800&28040200200801 crrY Everett STATE WA Z,, 98203 SUITE/UNIT#: Building A-B FLOOR M ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Northshore Christian Academy LEGAL DESCRIPTION for new construction: Short Plattsubdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Northshore Christian Academy OWNER MAILING ADDRESS: STREET 5700 23rd Drive crrY Everett STATE WA Z,p 98203 OWNER PHONE:425-407-1119 1OWNER EMAIL: CONTRACTOR COMPANY NAME:T.B.D. WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR:EMAIL: PRIMARY CONTACT: 11 OWNER ❑CONTRACTOR Z OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-252-2153 Todd Bullock/2812 Architecture CONTACT EMAIL:todd@2812architecture.Com BUILDING INFORMATION VALUATION OF WORK: $5,000 ASSOCIATED 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:Education PROPOSED USE OF BUILDING:Education HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: []Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): El New Construction ❑Addition ❑Remodel ❑Repair OT.I. ❑Change of Use ❑Modular ❑Portable ❑Re-roof El Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) []Other: DESCRIPTION OF WORK:Create new Office by installing partitions and a door in Corridor Of Building B, first floor. ACKNOWLEDGEMENT.1 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.I am the owner,or f 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. �b /-� City of Everett Official Use Only Tod B U I l OCk Digitally signed by Todd Bullock 07/20/2022 PERMIT# r � -Date:2022.07.20 08:47:09-0T00' Owner/Authorized Agent Signature Date (Revised 412112022) Z