1429 BROADWAY 2023-02-03 - Laserfiche WebLink

• E BUILDING PERMIT APPLICATtN 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 1429 Broadway ,` PARCEL#: 0075428701500 clry Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR • TION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residentia :Dr. Tae Youn & Dr. Lewlna Youn LEGAL DESCRIPTION for new construction: Short Plats Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:ELS Specialties, LLC OWNER MAILING ADDRESS: STREET 15808 Mill Creek Blvd., Suite 202 cIT., Mill Creek STATE WA ZIP 98012 OWNER PHONE:Dr. Tae Youn 213-210-3137 OWNER EMAIL: tyounddsmd@gmail.com CONTRACTOR COMPANY NAME:W.R. Hanson, Inc. WA STATE CONTRACTOR LICENSE#(REQUIRED):WRHAN**251 B1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 27589 CONTRACTOR ADDRESS: STREET12510 130th Lane NE crry Kirkland STATE WA ZIP 98034 CONTRACTOR PHONE:425-821-6747 CONTRACTOR EMAIL:pat@wrhansOn.cOm PRIMARY CONTACT: 0 OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-821-6747 Patrick Perkins CONTACT EMAIL:pat@wrhanson.com BUILDING INFORMATION VALUATION OF WORK: $32,300.00 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:651 Medical & Other Health Services PROPOSED USE OF BUILDING:Medical/Dental HEAT SOURCE: EGas ❑✓Electric ❑Other BUILDING TYPE: ESFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: (]Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ERemodel ❑Repair ❑T.I. ❑Change of Use EModular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑✓Other:Demolition for Future Tenant Improvement DESCRIPTION OF WORK:Selective removal of the interior non-bearing walls Building Shell to remain Existing Sewer, gas and electrical connections to remain intact 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 q_jic...X I , t PE # . r 14 '�� T lbdCt -c* Owner/Authoriz=�gent Signature Date (Revised 2/8/2021) BIZ