4201 RUCKER AVE COMMUNITY HEALTH CENTER 2024-04-12

BUfkING PERMIT APPLICATIO1 -� CITY OF EVERETT PERMIT SERVICES D ECEOVE EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requiremen d number of copies required fc iew, WASHINGTON then drop off completed application plus all required submittal documents to 32 edar fl�trr t F .Intake I Box. CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I V vereltWdigo(,/ errf,Wl�jj (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OF EVERETT PROJECT SITE ADDRESS: STREET 4201 Rucker Ave. PARCEL#: 005e220220pleTMRDOSerVitet 00582202200202 cm. Everett STATE WA- ZIP 98203 SUITE/UNIT#: FLOOR#: 3 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Community Health Center of Snohomish County LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Community Health Center of Snohomish County OWNER MAILING ADDRESS: STREET 8609 Evergreen Way cm. Everett STATE WA zip 98208 OWNER PHONE:425-789-3700 OWNER EMAIL: dkapetanov@chcsno.org CONTRACTOR COMPANY NAME:Aldrich&Assoc. WA STATE CONTRACTOR LICENSE#(REQUIRED):ALDRIA'202RU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 39375 CONTRACTOR ADDRESS: sTREET810 240TH ST SE cm. BOTHELL STATE WA ZIP 98021 CONTRACTOR PHONE:425-483-1313 CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-823-2244 or 425-241-0081 Janet Monda, Architectural Werks, Inc. CONTACT EMAIL:janetm@mdarchitects.com Cc: ryani@mdarchitects.com BUILDING INFORMATION VALUATION OF WORK: $40,000 ASSOCIATED LAND USE PROJECT#(if applicable):NA (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:Medical Clinic and Business Offices PROPOSED USE OF BUILDING:Medical Clinic and Clinic Offices HEAT SOURCE: ❑✓Gas ❑Electric DOther BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition DRemodel DRepair ❑✓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:The project consists of a remodel to an existing medical office building for use as a medical clinic. Interior remodel between corridor#302 and corridor#349 to include a new metal stud partition, doors, modified ceiling system, relocated lighting, and finishes. Modified electrical, HVAC, fire life safety and fire suppression systems shall be bidder designed by deferred permit. 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# st72. 3 06 ^ V 3 S� Johanna McManus I� �ad �-+a�w^�•--�w��-� 6/8/2023 Owner/Authorized Agent Signature Date (Revised 2/8/2021)