8609 EVERGREEN WAY COMMUNITY HEALTH CENTER 2022-10-14

B•DING PERMIT APPLICA•N CITY OF EVERETT PERMIT SERVICES EVERETTSUBMITTAL 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 8609 Evergreen Way PARCEL#: 28041300102900 cry Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: 2 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Community Health Center of Snohomish County LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Community Health Center of Snohomish County OWNER MAILING ADDRESS: STREET 8609 Evergreen Way cm, Everett STATE WA zip 98208 OWNER PHONE:425-789-3700 OWNER EMAIL: dkapetanov@chcsno.org CONTRACTOR COMPANY ME: A` ( h kS SLYi WA STATE CONTRACTOR LICENSE#(REQUIRED):Atip(MIF2CatidC1TYOF EVERETT BUSINESS LICENSE#(REQUIRED): 3-4-5 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-823-2244 or 425-241-0081 Janet Monda, Architectural Werks, Inc. 'CONTACT EMAIL:janet@awerks.com BUILDING INFORMATION VALUATION OF WORK: $400,000.00 estimated ASSOCIATED LAND USE PROJECT#(if applicable):NA (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:Business Offices PROPOSED USE OF BUILDING:Business Offices HEAT SOURCE: ✓❑Gas ❑Electric ❑Other BUILDING TYPE: LISFR ❑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:The project consists of a remodel to an existing office building for use as an office, no change. Interior renovations to include removal of interior partitions, doors, lighting and finishes. New work to include metal stud partitions, new doors, new ceiling systems, lighting and finishes. New electrical, HVAC, plumbing, fire suppression systems shall be bidder designed by deferred permit. 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. 1 City of Everett Official Use Only }4tAk-+ PERMIT# 00 1 Janet Monda /30/21 Owner/Authorized Agent Signature Date (Revised 2/8/2021) /7