10121 EVERGREEN WAY BASE FILE 2025-08-05

BUILDING PERMIT APPLICATIOI. ) 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 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 10121 Evergreen Way #1 PARCEL #: 28042400200100 clTr Everett STATE WA ZIP 98204 SUITEIUNIT #: #1 FLOOR M #1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANTIBUSINESS NAME (if non-residential): Vacant LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See attached Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: ROIC OWNER MAILING ADDRESS: STREET 11250 El Camino Real Suite 200 CITY San Diego STATE CA ZIP 92130 OWNER PHONE: 858-255-4920 OWNER EMAIL: rdoran@rolrelt.net CONTRACTOR COMPANY NAME: Select Contracting WA STATE CONTRACTOR LICENSE #(REQUIRED): SELECC" 83501 G CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 5'7✓7(p CONTRACTOR ADDRESS: STREET PO box 1746 city Bothell STATE WA 2IP 98041 CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR © OTHER (Please Specify) Architect CONTACT NAME: Scott Harris CONTACT PHONE: 206-369-8881 CONTACT EMAIL: SCott.harris@Sdharchltect.com BUILDING INFORMATION VALUATION OF WORK: $ 350000 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 - A-2 PROPOSED USE OF BUILDING: Retail - A-2 HEAT SOURCE: ❑✓ Gas ❑Electric [-]Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family -#Units: ❑✓Commercial ❑Accessory 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: DESCRIPTION OF WORK: Repair of fire damaged space. Replacement of storefront with new, like for like, damaged structural members. Replacement of HVAC units with like for like and overall interior cleanup of fire damage. Install new Grease Trap for future (not leased) tenant. No change in use or occupancy. ACKNOWLEDGEMENT: 1 have reviewed this application and confart the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal, state, and /me/ 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. 1 am the owner, or am authorized by the owner of this property to pedorm 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 6/27/23 PERMIT# �j L� Owner/Authorized Agent Signature Date (Revised 41212022)