4310 COLBY AVE 300 AND 301 2022-01-14

EVERETT WASHINGTON PERMIT APPLICATION BUILDINGOECHANICAL / PLUMBING / SIGN I10RINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:4310 Colby Ave. Everett I PROPERTY TAX #:00582202600200 LEGAL for new construction: Short Plat/subdivision South Park Addition Lot No (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Matana LLC TENANT BUSINESS NAME (Commercial): None OWNER MAILING ADDRESS: sTREETI 17 East Louisa Street #230 c,TY Seattle STATE WA Z,P 98102 OWNER PHONE: 206-226-1 70O 1OWNEIR EMAIL: Brad@seattleretai1.net CONTRACTOR NAME:OWner CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Brad Decker, Manager CONTACT PHONE:206-226-1700 CONTACT EMAIL:Brad@seattleretai1.net BUILDING INFORMATION Existing Use of Building: Medical & Dental Contract Price of Work: $10,000.00 Proposed Use of Building: Medical & Dental Heat Source: ❑Gas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse [-]Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ✓❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Remove two non structural walls and add a door. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures A/C — Air Handling Units Gas Piping Backflow Preventer (Inside Bldg) Shower, Tub, or Combo Boiler Gas Range Clothes Washer Sink -Commercial (3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink -Residential (kitchen, bath, bar) Duct System (Remodel) Refrigeration Drinking Fountain Sink -Utility, laundry, mop Exhaust Fans (Residential) Commercial Ventilatior (Not Heat/AC system) Floor Drain Toilet Exhaust Hood (Type 1) I Hose Bibb Urinal Exhaust Hood (Type II) Water Heater Interceptor -Grease Waste/Water Piping Repair Exhaust Hood (Residential) Wood Stove Interceptor-Sand/Oil Water Service (behind meter) Forced Air Systems I Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log I Roof Drains Water Heater SPRINKLER / SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System I INo. of Heads Chemical Suppression System I I No. of Heads 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 L�� 0, - Date (Revised 10 1012018) �/z