1330 COLBY AVE IRG PHYSICAL THERAPY 2023-09-25

BUILDING PERMIT APPLICATION 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 1330 Colby Ave. PARCEL#: 00438524501700 cm, Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):IRG PHYSICAL THERAPY LEGAL DESCRIPTION for new construction: Short Plat/subdivision: EVERETT DIV R Lot No.: 17-18 (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Tim Thomas-IRG Physical Therapy MA)v iY OWNER MAILING ADDRESS: STREET 4220 132ND STREET SE SUITE 202 cm MILL CREEK STATE WA ZIP 98012 OWNER PHONE:425-374-2846 OWNER EMAIL: CONTRACTOR COMPANY NAME:TBD U tN V JJ WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL:tim.tomas@irgpt.com PRIMARY CONTACT: i] OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) 2812 Architecture CONTACT NAME: CONTACT PHONE:425-343-2153 Paul(2812 Archituecture),Clint(2812 Architecture) CONTACT EMAIL:paul@2812architecture.com BUILDING INFORMATION VALUATION OF WORK: $25,000 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:Business PROPOSED USE OF BUILDING:Business HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ET.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: 1993 S.F. tenant improvement with some demolition 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 0 •'cial 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 corn ly with th:'.tate Contractors Law 18.27 RCW and 296.200A WAC. .® City of Everett Official Use Only /',��►�� f PERMI # ^Owner/Authorize• Agent Signature D//11P'1 (Revised 2/8/2021) 1/