1717 13TH ST FLOOR 2 EVERETT CLINIC 2022-05-06

• BUILDING PERMIT APPLICATIR 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1717 13th Street PARCEL#: cry Everett STATE WA zip 98201 SUITE/UNIT#: FLOOR#: Level 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Providence Regional Cancer Partnership LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Providence Health&Services OWNER MAILING ADDRESS: STREET 1321 Colby Avenue CITY EVe STATE WA Zip 98201 OWNER PHONE:425-218-09 NER EMAIL: James.Grafton@providence.org CONTRACTOR COMPANY NA E: WA STATE CONTRACTOR LI NSE#(REQUIRED): 'u F EVERETT BUSINESS LICENSE#(REQUIR ):tA\QM CONTRACTOR ADDRESS: TREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-259-0868 Devi n Saylor CONTACT EMAIL:devin@bnharch.com BUILDING INFORMATION VALUATION OF WORK:$750,000.00 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 Clinic PROPOSED USE OF BUILDING: B Occupancy Clinic HEAT SOURCE: ❑✓Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑✓T.I. EChange of Use ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ElTank(above ground) ❑Other: DESCRIPTION OF WORK: The scope of work includes replacing an existing Tomography unit and Linear Accelerator unit with new replacement units. Minor remodel work is required. 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.lam the owner,or lam 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 6.200A WAC. City pooff Everett Official Use Only PE IT#�V 7-14-2021 �J v Owner/Authorized Agent Signature Date (Revised 2/8/2021) y