4310 COLBY AVE 2022-04-04 - Laserfiche WebLink

BIDING PERMIT APPLICATN CITY OF EVERETT PERMIT SERVICES E V E E T T 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4310 Colby Ave PARCEL#: 00582202600200 crrr STATE WA ZIP 98203 SUITE/UNIT#: FL' •R#:3rd,) ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residents'- :PrOVidence Medical Group Urology LEGAL DESCRIPTION for new construction: Short Plat/subdivision: see cover sheet Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Christian Decker OWNER MAILING ADDRESS: STREET 11 Sunset Ave N, Suite 200 CITY Edmonds STATE WA zip 98020 OWNER PHONE:206-972-0707 OWNER.EMAIL: christian.decker@seattleretail.net CONTRACTOR COMPANY NAME:Ferris Turney.,(Sean Rankin) _ - C�Ei2f/ Co CO3 ___ );„ WA STATE CONTRACTOR LICENSE-#RE IRED :604809994 ` ITY OF EVERETT BUSINESS LICENSE#REQUIR • 050444 CONTRACTOR ADDRESS: STREET 118 N 35th Stre crry Seattle STATE WA ZIP 98103 CONTRACTOR PHONE:206-889-01 02 CONTRACTOR EMAIL:seanr@ferriS-turney.COm PRIMARY CONTACT: ❑ OWNER L✓J CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-599-4463 Gina Dais CONTACT EMAIL:gdais@tgbarchitects.com BUILDING INFORMATION VALUATION OF WORK: $180,000 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:B Occupancy - Medical PROPOSED USE OF BUILDING:B Occupancy - Medical 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:Remodel of existing dental clinic into expansion of 2nd floor Urology clinic. 713SF 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# 10n8,21121 Y) ( -C43 Owner/Authorized Agent Signature Date (Revised 2/8/2021)