405 SE EVERETT MALL WAY 2025-04-21

B•DING 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 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 405 SE Everett Mall Way PARCEL#: 28051800304100 CITY Everett STATE WA ZIP 98208 SUITE/UNIT#: N'A FLOOR#: N/A ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Target Corporation LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: 1 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Target Corporation,Attn:Dane Jaster OWNER MAILING ADDRESS: STREET PO Box 9456 CITY Minneapolis STATE MN ZIP 55440-9456 Dane.Jaster target com OWNER PHONE: 'OWNER EMAIL: C�'-"��'•--�' CONTRACTOR COMPANY NAME:To be determined e n S-h- ch on WA STATE CONTRACTOR LICENSE#(REQUIRED): fjI_ Lg(o( K CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): re(opt- 'ZZ CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: El OWNER ❑CONTRACTOR R1 OTHER(Please Specify) Authorized Agent CONTACT NAME: CONTACT PHONE:330-572-3575 GPD Group.Professional Corporation.Attn:Ian Russell on behalf of Tesla.Inc. CONTACT EMAIL:gpdchargepermits@gpdgroup.com BUILDING INFORMATION VALUATION OF WORK: $164,007 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:Commercial PROPOSED USE OF BUILDING:Commercial HEAT SOURCE: ❑Gas ❑Electric ❑✓Other" BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial [IAccessory 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:Electric Vehicle Charging Station DESCRIPTION OF WORK: Electric vehicle charging station located in the existing parking lot. Will include the installation of the following: (1) utility transformer, (1) step-down transformer with integrated sub-panel, (1) switchgear assembly with integrated master controller, (3) V3 Supercharger Cabinets, (12) V3 Charging Posts, and (2) dual-port level 2 charge posts. 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 PERM IGWI/ .� ' 9/3/21 4. R. 0 Owner/Authorized Agent Signature Date (Revised 2/8/2021) V 7