405 SE EVERETT MALL WAY 2025-04-21

PIOILIC WORKS PERMIT IPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS:405 SE Everett Mall Way SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑TOWNHOUSE ['DUPLEX EADU ❑MULTI-FAMILY ['COMMERCIAL ['INDUSTRIAL IF APPLICABLE: ❑ LAND USE PROJECT#(SEPA, PRE-APP, SS, ETC.) IF APPLICABLE: ❑ FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK / RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WORK BELOW,AS APPLICABLE: DRAINAGE MITIGATION QUESTIONS: ❑FENCE IN ROW FT IN HEIGHT STORMWATER DISCHARGES TO: ❑DRIVEWAY APRON/CURB CUT FT WIDE ❑ Combined Sewer ❑✓ ASPHALT/CONCRETE PAVING 795 SF ❑✓ Separated Storm Sewer LI RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF ❑ Direct Discharge to Snohomish River or Puget Sound ❑ RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIGHT TRIGGERED REQUIREMENTS: ❑✓ CLEARING/GRADING/FILL/EXCAVATE 19 CY ❑ MR2 Only ❑ MR1-5 ❑ MR1-9 ❑✓ CUT/BORE IN PAVEMENT(PARALLEL) 380 LF QUANTITY OF PROPOSED HARD SURFACES: ❑ CUT/BORE IN PAVEMENT(NON-PARALLEL) LF Proposed Roof Area:0 SF ❑ POLE WORK/AERIAL/OVERLASH LF Proposed Hardscape:-236 SF ADDITIONAL DESCRIPTION (AS NEEDED): Total New+Replaced:795 SF Electric vehice charging station located in the existing parking lot. Includes: (1) utility transformer, (1) step-down transformer with integrated sub-panel, (1) switchgear assembly, (3) V3 Supercharger Cabinets, (12) V3 Charging Posts, and (2) dual-port level 2 charge posts. CONTACT INFORMATION OWNER/APPLICANT NAME:GPD Group, Professional Corporation on behalf of Tesla, Inc. OWNER/APP. MAILING ADDRESS: STREET520 South Main Street CITY Akron STATE OH ZIP 44311 OWNER I APP. PHONE:330-572-3575 OWNER/APP. EMAIL:gpdchargepermits@gpdgroup.com *Required for Work in Public Right-of-Way CONTRACTOR NAME: To be determined 13/akk,c-1- n (-f Q7 L-L(, CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: ^r K.CONTRACTOR LICENSE#(REQUIRED): g�1i li��G�� 1p(0;°�1 r EVERETT BUSINESS LICENSE#(REQUIRED): COip (� Z- PRIMARY CONTACT: ❑ OWNER /APPLICANT ❑CONTRACTOR ❑✓ OTHER(Architect, Engineer, Etc.) Authorized Agent CONTACT NAME: CONTACT PHONE:330-572-3575 GPD Group.Professional corporation'.Attn,.Ian Russell on bohall of Testa,Inc CONTACT EMAIL:gpdchargepermits@gpdgroup.com 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# Ian/R.tAis-sP7777v 9/3/21 PW V l /U Owner/Authorized Agent Signature Date (Revised 1/72019)