1920 100TH ST SE 2023-06-28 - Laserfiche WebLink

fia PERMIT APPLICATION* LI BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:192C) 100th St. SE Bldg. A& B, Everett, WA 98208(PROPERTY TAX#:28052000202100 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Sea Mar Community Health Centers TENANT BUSINESS NAME(Commercial): Sea Mar OWNER MAILING ADDRESS: STREET 1040 South Henderson cm, Seattle STATE WA ZIP 98108-4720 OWNER PHONE: 425.637.0831 OWNER EMAIL: Ir z1 CONTRACTOR NAME: `fAL ( &js . 011) 3Y CONTRACTOR ADDRESS:- TREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED)A J -G3 OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 09 5G PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:206.849.2860 Jose O. Bazan CONTACT EMAIL:josebazan@b)Zarterchl&t.s.com BUILDING INFORMATION/ �+ Existing Use of Building:Medical Office Clinic Contract Price of rk:$05J000 00 fSk CL)v Proposed Use of Building:Medical Office Clinic Heat Source: ❑Gas DElectric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure Type of Project: ❑New ©Addition LiRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Addition between existing building A and building B. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler _ Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) _ Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet Exhaust Hood(Type I) _ (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) _ Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System -' No.of Heads 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 he 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 P ITZO (9 •u er th. ,zed A. •nt Signature Date (Revised 10/10/2018)