5908 EVERGREEN WAY 2022-10-06 - Laserfiche WebLink

FOLDING PERMIT APPLICASON 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5908 Evergreen Way PARCEL#: 00393200600103 CITY Everett STATE WA zip 98203 SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable):North Classroom TENANT/BUSINESS NAME(if non-residential):HOUSing Hope - 'loan nm oYYDO'S -\ope- Octl�Lc c� LEGAL DESCRIPTION for new construction: Short Plat/subdivision: See attached Lot No.: J (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Housing Hope OWNER MAILING ADDRESS: STREET 5830 Evergreen Way CITY Everett STATE WA ZIP 98203 OWNER PHONE:425 322 3723 x 222 OWNER EMAIL: brycelevin@housinghope.org CONTRACTOR COMPANY NAME:TBD ^ /Oa %pi()577711-UGf1OA) P/!pf s�1C� WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Dykeman Architects CONTACT NAME: CONTACT PHONE:425 259 3161 Doug Hofius, Dykeman Architects CONTACT EMAIL:dough@dykeman.net BUILDING INFORMATION VALUATION OF WORK: $2U OQ)D S, ovV Vt9 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:AdUlt Classroom (B occupancy) PROPOSED USE OF BUILDING:Childcare (E occupancy) 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:Change of use of existing 1,100 s.f. Adult classroom from occupancy class B to child care center for children over the age of 5, occupancy class E. 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only t0 PERMIT# � J Nort— , Owner/Authorized Age ignature U Date (Revised 4/21/2022) )