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BUISIING PERMIT APPLICATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1130-D SE Everett Mall Way PARCEL#: 28051800402200 <br /> CITY Everett STATE WA ZIP 98208 <br /> SUITE/UNIT#: unit"D" FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): former BedBath&Beyond <br /> TENANT/BUSINESS NAME (if non-residential):Everett Village <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:PAPF Everett, LLC <br /> OWNER MAILING ADDRESS: STREET 101 Larkspur Landing Circle, Suite 120 <br /> CITY Larkspur STATE CA ZIP 94939 <br /> OWNER PHONE:415-413-0713 OWNER EMAIL: bmcnamara@argoinvest.com <br /> CONTRACTOR COMPANY NAME:TCL Partners <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):TCLPAPC919QD CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 049073 <br /> CONTRACTOR ADDRESS: STREET 16000 Mill Creek Blvd, Suite 103 <br /> cITY Mill Creek STATE WA ZIP 98012 <br /> CONTRACTOR PHONE:425-316-3515 CONTRACTOR EMAIL:rcaton@tclpartners.com <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architectural Project Manager <br /> CONTACT NAME: CONTACT PHONE:503-546-1609 <br /> Melinda VerMeer CONTACT EMAIL:melindav@baysingerpartners.com <br /> BUILDING INFORMATION <br /> VALUATION OF WORK: $10,000 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:M -Mercantile(vacant shell) <br /> PROPOSED USE OF BUILDING:M-Mercantile (vacant shell,future TI permit to be submitted early summer) <br /> HEAT SOURCE: ❑✓Gas ❑Electric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓Repair ❑T.I. ❑Change of Use <br /> El Modular El Portable ID Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK: Repair/replacement of roof truss where former tenant's mezzanine elevator was <br /> removed under demo permit #B2110-004 (completed and closed out earlier this year). <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 must first be authorized in writing from the <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# FZZOS 65` <br /> Digitally signed by Melinda VerMeer 5(17/2022 / <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />