1920 100TH ST SE 2021-12-13 - Laserfiche WebLink

1* • PERMIT APPLICATION EVERETT WASHINGTON BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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: 1920 100TH ST. SE BLDG A, EVERETT, WA 98208 PROPERTY TAX #: 28052000202100 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: SEA MAR COMMUNITY HEALTH CENTERS TENANT BUSINESS NAME (Commercial): SEA MAR OWNER MAILING ADDRESS: ITlEIT1040 SOUTH HENDERSON caTY SEATTLE STATE WA zip 98108 OWNER PHONE: 425.637.0831 OWNER EMAIL:JOSEBAZAN@BAZANARCHITECTS.COM CONTRACTOR NAME: CONTRACTOR ADDRESS: SFREEi CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER (Please Specify) ARCHITECT/AGENT CONTACT NAME: JOSE O. BAZAN CONTACT PHONE:206.849.2860 CONTACT EMAIL:JOSEBAZAN@BAZANARCHITECTS.COM BUILDING INFORMATION Existing Use of Building: MEDICAL CLINIC lContract Price of Work: $145,000 (NO MEP) Proposed Use of Buildin :MEDICAL CLINIC Heat Source: ❑Gas []Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑✓ Commercial ElAccessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 21T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use DESCRIPTION OF WORK: NO CHANGE ON MAIN STRUCTURE. INTERIOR PARTITION RECONFIGURATION. NEW FINISHES AND LIGHTING. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture Count List of Fixtu s, Fixture Count List of Fixtures Fixture Count List of Fixture i A/C — Air Handling Units Gas P' ' g Backflow Preventer (Inside Bldg) Shower, Tub, or mbo Boiler Range Clothes Washer Sink -Co rcial (3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Si esidential (kitchen, bath, bar) Duct System (Remod Refrigeration Drinking Fountain ink -Utility, laundry, mop Exhaust Fans R I n Commercial Ventilatior (Not HeaUAC system) Floor Drain Toilet Exhaust Hoo Hose Bibb Urinal Exhaust o pe II) Water Heater Interceptor-Greas Waste/Water Piping Repair Exhaust tjo2 (Residential) Wood Stove Interceptor-S n / Water Service (behind meter) Forc Ai ystems Other: Medical ka Water Valves or Fixtures gars' Fireplace/Insert/Log Roof Dra' Water Heater SfPRINKLER I SUPPRESSION SYSTEM Se a Ejector or Sump Pump Other: Water Suppression System I No. of Heads Chemical Suppression System No. of Heads ACKNOWLEDGEMENT: 1 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 / am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. nerlAutho ed Ag lxgnature Date City of Everett Official Use Only PERMIT fli K� (X I �� ::1 (Revised 1011012018) 0