5130 EVERGREEN WAY COMMUNITY MEDICAL SERVICES 2025-05-09

L� -tDING PERMIT APPLICAWN 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)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 5130 Evergreen Way PARCEL#: 00402900000202 CITY Everett STATE Washington ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):CMS (Community Medical Services) LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:Todd Stingley OWNER MAILING ADDRESS: STREET 8444 N 90th Street Suite 100 CITY Scottsdale STATE Arizona ZIP 85258 OWNER PHONE:602-248-8886 M,M /-. OWNER EMAIL: todd.stingley@cmsgivehope.com CONTRACTOR COMPANY NAIVE: ] �( �1' I�) 4.-1 r WA STATE CONTRACTOR LIONS (REQUIRED): IF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ta�G/ D CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:541-728-1747 Melissa Martorano CONTACT EMAIL:mmartorano@waremalcomb.com BUILDING INFORMATION VALUATION OF WORK: $430,000(FOR ALL CONSTRUCTION) 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:Office PROPOSED USE OF BUILDING:Office HEAT SOURCE: ❑Gas ✓❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑Repair ❑✓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 SCOPE OF THIS PROJECT IS 2ND GENERATION INTERIOR OFFICE IMPROVEMENT CONSISTING OF DEMOLITION, NEW PAR 1110 T MECHANICAL, ELECTRICAL, PLUMBING, MILLWORK, GL `-ra dEB� APR 1 7 2023 CITY OF EVERETT Permit services 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 Digitally signed by Melissa Martorano q Melissa Martorano llrOat8 2 s304.12 ranorano@waremalcomb,com", O4/12/2O23 PER SO, r Date:2023.04.1210.48.04-07'00' ‘;oeC)� t"�\, "" (J-� Owner/Authorized Agent Signature Date (Revised 4/21/2022)