1130 SE EVERETT MALL WAY HOME GOODS 2023-06-22

MILDING PERMIT APPLICA1N 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1130 SE Everett Mall Way PARCEL#: 28051800405800 CITY Everett STATE WA ZIP 98208 SUITE/UNIT#: Suite D FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):HomeGoods LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:RedBird Everett Village LLC OWNER MAILING ADDRESS: STREET 101 Larkspur Landing Cir Ste 120 CITY CA STATE Larkspur ZIP 94939 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME'N* a. Dpw(s 4 y WA STATE CONTRACTOR LICENSE#(REQUIRED): it 4 Q0 0 6I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET Lf1 -re 2.A( JA-I(� CITY J STATE � ZIPCONTRACTOR PHONE:PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Agent CONTACT NAME: CONTACT PHONE:817-529_6879 Erica B a re I a CONTACT EMAIL:erica@roguearchitects.com BUILDING INFORMATION VALUATION OF WORK:$ 1, 600 600 / Co O,,cc" 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:Retail PROPOSED USE OF BUILDING:Retail HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ElAccessory Structure TYPE OF PROJECT(check all that apply): ENew Construction ❑Addition ❑Remodel ❑Repair ET.I. ❑Change of Use EModular EPortable ❑Re-roof ❑Exterior Alteration ETank(above ground) ❑Accessory Structure EFence over 7ft high ❑RackStorage ❑Pool/Hot Tub ETank(above ground) ❑Other: DESCRIPTION OF WORK: Tenant finish out with no exterior work. 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 Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# C/L� 09/13/2022 C_ Owner/Authorized Agent Signature Date (Revised 4/21/2022)