4201 RUCKER AVE COMMUNITY HEALTH CENTER 2022-10-07

BIDDING PERMIT APPLICATSI 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 4201 Rucker Ave. PARCEL#: 00582202200101,00582202200102,00582202200201.00582202200202 cn. Everett STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: 1,3 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 city Everett STATE WA zip 98208 OWNER PHONE:425-789-3700 OWNER EMAIL: dkapetanov@chcsno.org CONTRACTOR COMPANY NAME:TBD - bid process is not completed ,y� ((j v I Y' A A SSOU c>K-S, l c- WA STATE CONTRACTOR LICENSE#(REQUIRED): I,I)JIq 0.2.0,2RVt,CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 q 3 7 S 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 ItnAi-t1 / tic) BUILDING INFORMATION VALUATION OF WORK: $5;4eee eee"B0 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:Medical Clinic and Business Offices PROPOSED USE OF BUILDING:Medical Clinic and Clinic Offices 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 1T.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 medical office building for use as a medical clinic. Interior renovations to include removal of interior partitions, plumbing, casework, lighting and finishes. Remodel to include a dental clinic, physical therapy gym and pharmacy. New work to include metal stud partitions, casework, 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 944—71/1"‘"l& PERMIT# City of Everett Official Use Only agent November 30,2021 0 Oe3 Owner/Authorized Agent Signature Date (Revised 2/8/2021) i/ Z