4027 HOYT AVE BASE FILE 2021-11-15

Now BLSDING PERMIT APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL 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((W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4027 Hoyt Ave PARCEL#: 00582101101100 CITY Everett STATE WA zip 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):The Everett Clinic LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION` OWNER NAME:McCarty Ralph J Family LP OWNER MAILING ADDRESS: STREET 2623 Taylor Dr CITY Everett STATE WA ZIP 98203 OWNER PHONE:425-328-6837 OWNER EMAIL: scottJawson@uhg.com CONTRACTOR COMPANY NAME:Andersen Construction of Washington LLC WA STATE CONTRACTOR LICENSE#(REQUIRED);ANDERC*907DN (CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 57819 CONTRACTOR ADDRESS: STREET 5601 6th Ave S,STE 550 cry Seattle STATE WA zip 98108 CONTRACTOR PHONE:206-763-6712 CONTRACTOR EMAIL:PParsons@andersen-const.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-293-7774 Paul Parsons CONTACT EMAIL:pparsons@andersen-const.com BUILDING INFORMATION VALUATION OF WORK: $72,291 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:Medical Clinic PROPOSED USE OF BUILDING:Medical Clinic 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: Repairs to roof, reinforcing trusses, and replacing finishes damaged from fire. 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# Y is_, b Cgp.i,r}Prf tyP.W P.ip.ro Paul Parsons Canmumm.IXMPwI Pwnaa .•mi.:aor.oa,sv:nssona Owner/Authorized Agent Signature Date (Revised 2/8/2021) /2—