1425 SE EVERETT MALL WAY GAME ON NW 2022-04-01

E BIDING PERMIT APPLICATI] 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1425 SE EVERETT MALL WAY PARCEL#: 28051800404600 cm/ EVERETT STATE WA ZIP 98208-2850 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Game On NW LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Brad Halbach OWNER MAILING ADDRESS: STREET 12411 VENTURA BLVD cITY STUDIO CITY STATE CA ZIP 91604 OWNER PHONE: OWNER EMAIL: brad@hightrekeverett.com CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: ., 9 PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR OTHER(Please Specify) a CONTACT NAME: CONTACT PHONE:(425) 252 2153 Paul Douglas 2812 Architecture),Clint Johnson CONTACT EMAIL:paul@2812architecture.com, Clint@2812architecure.com BUILDING INFORMATION VALUATION OF WORK: $100,000 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:A3 PROPOSED USE OF BUILDING:A3 HEAT SOURCE: ❑Gas ❑Electric ❑Other BUILDING TYPE: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair Lg'r ❑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:9 996 SF TENANT IMPROVEMENT ASSOCIATED WITH AN AMUSEMENT CENTER TO BE LOCATED WITHIN THE EXISTING BUILDING 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 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 L w 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 11 O ^ 0 5o Owner/Authorize gent Si nat retilic . /40 , /cif r Dater (Revised 2/8/2021) �,, t 11 )