1615 75TH ST SW HOME HEALTH AND HOSPICE 2022-01-24

1111111111 uni B LDING PERMIT APPLICAT1 CITY OF EVERETT PERMIT SERVICES EVERETT 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 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1615 75th St SW PARCEL#: 28041100101100 orrY Everett, STATE WA ZIP 98203 SUITE/UNIT#: 200 FLOOR II:2nd ADDITIONAL LOCATION INFORMATION (if applicable):Everett Technical Pads 1 TENANT/BUSINESS NAME(if non-residential): Home Health and Hospice in Everett LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Sabey Corporation OWNERMAILINGADDRESS: STREET 12201 Tukwila International Blvd crn Seattle STATE WA ZIP 98168 OWNER PHONE: 206 . 281 . 8700 OWNER EMAIL: joes@sabey.com CONTRACTOR COMPANY NAME:Ron Hutchinson ‘4111it (M1 tell k Yl AIR0v1 `I r tf A 3 0 2 WA STATE CONTRACTOR LICENSE#(REQUIRED): HUTCHCCO 7 5LP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); C r CONTRACTOR ADDRESS: STREET PO Box 482 any Manchester STATE WA ZIP 98353 CONTRACTOR PHONE:360.710.2380 CONTRACTOR EMAIL:hutchconinc@msn.com PRIMARY CONTACT: ©OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:206.962.6459 John R. Leuck CONTACT EMAIL:john.leuck@mg2.com BUILDING INFORMATION VALUATION OF WORK:$ 1, 460, 000. 00 ASSOCIATED LAND USE PROJECT#(if applicable): (Valuation shall include the prevaltng fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) EXISTING USE OF BUILDING: Empty PROPOSED USE OF BUILDING: B Business HEAT SOURCE: ❑Gas 1Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Change of Use ElModular ❑Portable ❑Re-roof ❑Exterior Alteration ElTank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other. DESCRIPTION OF WORK Tenant improvement for a new work space for the Home Health and Hospice team for Providence. No structural or exterior work to be done. All interior. 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.t am the owner,or 1 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 ROW and 296.200A WAG. City of Everett Official Use Only PER IT 03.23 .2021 1 '1- Ot9t owner/Authorized Agent Signature Date (Revised 218/2021)