1820 100TH PL SE 2023-01-03 - Laserfiche WebLink

B•DING PERMIT APPLICATION 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 1820 100th Place SE PARCEL#: 00659600000400 cm, Everett STATE WA ZIP 98208 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential): ICON Dental Center LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Silver Lake Prof.Ctr.Blk.000 D-00 Lot No.: 4 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: (Tenant) ICON Dental Center c/o Nadia Aboulhosn and Joanna Valentine OWNER MAILING ADDRESS: STREET 1820 100th Place SE CITY Everett STATE WA ZIP 98208 OWNER PHONE: (Tenant) (425)337-2400 OWNER EMAIL: naboulhosn©icondentallcenter.com CONTRACTOR COMPANY NAME: (Not Selected Yet) Tv't etcpp-\t\9AV` C-1 f-►ra c4 WA STATE CONTRACTOR LICENSE#(REQUIRED):MI?L G L 86 G.2JS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: I]OWNER ❑CONTRACTOR i]OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE: (425)697-0983 Richard A. Okimoto, Architect CONTACT EMAIL: raoarch©outlook.com BUILDING INFORMATION VALUATION OF WORK: $ 250,000 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: Professional Offices - Dental PROPOSED USE OF BUILDING: Professional Offices - Dental 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: Interior remodel for the existing tenant, ICON Dental Center, with no additional building area. Exterior changes limited to addition of a new exit door, replacement of existing front entry door, and secondary exit door at Staff Lounge; new concrete stoop and steps at west side. Interior remodel limited to new, non-bearing interior walls, replacement of dental equipment and furnishings, selected replacement of light fixtures, and change of floor and wall finishes. 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# 52_ ti 0 0 4---/ Own r A razed Agent Signature Date (Revised 2/8/2021) t/Z--