12906 19TH AVE SE JOINT CHIROPRACTIC 2023-02-06

NEN Ira BSDING PERMIT APPLICAION 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 12906 BOTHELL-EVERETT HWY-SUITE B PARCEL it: 28053000406200 CITY Everett STATE WA ZIP 98208 SUITE/UNIT it: B FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): Fred Meyer Shopping Center TENANT/BUSINESS NAME(if non-residential):Joint Chiropractic LEGAL DESCRIPTION for new construction: Short Plat/subdivision: SEC 30 TWP 28 RGE 05-LOT 1 Lot No.: 1 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:FRED MEYER STORES INC OWNER MAILING ADDRESS: STREET 1014 VINE ST FL 7 CITY CINCINNATI STATE OHIO ZIP 45202 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER LI CONTRACTOR I:OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:206-310-0827 Vicki Somppi CONTACT EMAIL:vickis@workplacearchitecture.com BUILDING INFORMATION VALUATION OF WORK:$12000 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:B-HAIR SALON/Personal Services PROPOSED USE OF BUILDING:B-Medical Services(Chiropractic) HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex LIADU ❑Multi Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): New Construction ❑Addition ❑Remodel ❑Repair E IT.I. ❑Change of Use El Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure LI Fence over 7ft high ❑RackStorage ElPool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:SCOPE OF WORK FOR EXISTING VACANT SUITE IS TO PROVIDE ONE PRIVACY WALL FOR THE TREATMENT AREA AS SHOWN, MINOR MODIFICATIONS OF THE EX. OFFICE, AND RELOCATE THE RESTROOM SINK AND CHANGE THE DOOR SWING TO PROVIDE CLEAR ACCESS TO THE TOILET AND SINK. TO MEET CURRENT CODE REQUIREMENTS FOR SHARED RESTROOM. NEW LED LIGHTING WILL BE PROVIDED AS PART OF THIS TI. 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 �i-y signed by Vicki Somppi E d1S, icks@wo tectur e.com, PERM uT�#Vicki Som 'rka Aecture,OU=Workplace.• ure,CIV=Vicki Somppi 3 G^.►/ O SO 2022.03.07 21.22.16-08'00' Owner/Authorized Agent Signature Date (Revised 2/8/2021) f 1/.