3224 COLBY AVE 2023-02-06 - Laserfiche WebLink

mum BfLDING PERMIT APPLICATRN 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 3224 COLBY AVE PARCEL#: 00439176802100 crTr EVERETT STATE WA Zip 98201 SUITE/UNIT#: B FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Puget Sound Pediatric Dentistry LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:ROBERT TROSVIG OWNER MAILING ADDRESS: STREET 1620 SILVER LAKE DR CITY EVERETT STATE WA zip 98204 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:ON THE MARK CONSTRUCTION it � WA STATE CONTRACTOR LICENSE#(REQUIRED): tA� .. —+`L$A I r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): uO1 63 CONTRACTOR ADDRESS: STREET901 WEBSTER STREET city MUKILTEO STATE WA zip 98275 CONTRACTOR PHONE:206-915-1256 CONTRACTOR EMAIL:MARK@ONTHE MARK.CONSTRUCTION PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) ARCHITECT CONTACT NAME: CONTACT PHONE:425-252-2153 ADAM CLARK 2812 ARCHITECTURE CONTACT EMAIL:ADAM@2812ARCHITECTURE.COM BUILDING INFORMATION VALUATION OF WORK: $8,000 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:DENTAL OFFICE PROPOSED USE OF BUILDING:DENTAL OFFICE HEAT SOURCE: ❑✓Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU EMulti-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: 118 S.F. OPERATORY ENCLOSURE WITHIN AN EXISTING DENTAL OFFICE 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# db.i ni .lu� 2o2j "if Owner/Authorized Agent Signature Date (Revised 2/8/2021) �I2