5901 23RD DR W PROVIDENCE 2023-05-22

• • BUILDING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVER E T T 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)PermitServices@everettwa.gov l(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5901 23rd Drive West Suite 105 PARCEL#: 01118500000100 crry Everett STATE WA ZIP 98203 SUITE/UNIT#: 105 FLOOR#:1 ADDITIONAL LOCATION INFORMATION(if applicable): TENANT/BUSINESS NAME(if non-residential):Providence HME LEGAL DESCRIPTION for new construction: Short Plat/subdivision: sec 20 town289 range4 Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Seaway Corporate lot 3C LLC OWNER MAILING ADDRESS: STREET 4932 NE 97th St CITY Seattle STATE WA ZIP 98115 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANYNAME:HUtch-COn Construction Inc. �— - ��` WA STATE CONTRACTOR LICENSE#(REQUIRED):l�uJ l .J-CC \OI ERETT BUSINESS LICENSE#(REQUIRED): 63124 CONTRACTOR ADDRESS: STREET r O Box 482 ��J CITY Manchester STATE WA ZIP 98353 CONTRACTOR PHONE:360.871.6188 CONTRACTOR EMAIL:hUtChcOflifIC C!mSf.cOm PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify)Architect CONTACT NAME: CONTACT PHONE:206.962.6459 John R. Leuck CONTACT EMAIL:john.leuck@mg2.com BUILDING INFORMATION VALUATION OF WORK:$ 600,000 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:S1 and S2, B PROPOSED USE OF BUILDING:S1 and S, B HEAT SOURCE: DGas ❑✓Electric DOther BUILDING TYPE: DSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑✓Commercial EAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction DAddition ❑Remodel ❑Repair DTI ❑Change of Use DModular ❑Portable ❑Re-roof DExterior Alteration ❑Tank(above ground) DAccessory Structure ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) DOther: DESCRIPTION OF WORK:increase the breakroom and restroom spaces, while maintaining the warehouse space for home medical equipment storage in the warehouse. No structural work is anticipated. 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 - - Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PE �?_D5 May 05,2022 Owner/Authorized Agent Signature Date (Revise 4/IT21/2022)