118 SE EVERETT MALL WAY 2022-03-23

Bl]ILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL 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 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 118 SE Everett Mall Way PARCEL M 00369600001000 CITY Everett STATE WA ZIP 98208 SUITEMNIT M FLOOR M 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME (if non-residential): Blackwood Builders Group LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See attached document Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Blackwood Builders Group OWNER MAILING ADDRESS: STREET 118 SE Everett Mall Way LLC CITY Everett STATE WA ZIP 98208 OWNER PHONE: Aaron Mounsey OWNER EMAIL: aaron@blackwoodbuildersgroup.com CONTRACTOR COMPANY NAME: Blackwood Builders Group LLC WA STATE CONTRACTOR LICENSE #(REQUIRED): BLACKBG862132 CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 055701 CONTRACTOR ADDRESS: STREET 118 SE Everett Mall Way Cln. Everett STATE WA ZIP 98208 CONTRACTOR PHONE: Cameron Willett CONTRACTOR EMAIL: cameron@blackwoodbuildersgroup.com PRIMARY CONTACT: ❑ OWNER ❑✓ CONTRACTOR ❑✓ OTHER (Please Specify) 11Maloomb CONTACT NAME: Leticia Lucero CONTACT PHONE:206.310.5198 CONTACT EMAIL: LLucero@waremalcomb.com BUILDING INFORMATION VALUATION OF WORK: $110,000.00 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: Prior use Merchant PROPOSED USE OF BUILDING: Office 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 ❑✓ Remodel ❑✓ Repair ❑T.I. ❑Change of Use ❑Modular ❑Portable ❑Re -roof ❑Exterior Alteration ❑Tank (above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank (above ground) ❑Other: DESCRIPTION OF WORK: Moderate fire damage requires the partial rebuild of roof. Providing ADA restrooms and installing water foundation to comply with current codes. fo2'+nGAlil`3 • C,,1UA' &9; OF W;&' Ik -Po 9 - XW Of7&9, j(b4 �cSl%oo�Sl f�t'� 10A7sT t1'67C t2t�rh �. 7z) 4-m G w i rw sc wi C s`rAkcn44/,f f _ 40ar2.c� . ACKNOWLEDGEMENT: l 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 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. a Lefiaa Lucero Owner/Authorized Agent Signature Date City of Everett Official Use Only PERMIT # Tax-1W 21Q _ 002 (Revised 21812021) y-,7- W7.lof-60"L -