5130 EVERGREEN WAY COMMUNITY MEDICAL SERVICES 2025-05-09

ME' 'ANICAL PERMIT APPLIC 'ION D 1 ©1V1 1 CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plan to 3200 r Str e d f porAtpt��Ce Dro x. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 I(E)PermitServices@everettwa.gov„ eve a tv,, v))pe{�i}}{tt& (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY OF FVFPP jT PROJECT SITE ADDRESS: STREET 5130 Evergreen Way PARCEL#: 00402900o0o��rmit Services CITY Everett STATE Washington ZIP 98203 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):CMS(Community Medical Services) 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 OWNER EMAIL:todd.stingley@cmsgivehope.com CONTRACTOR COMPANY NAME:TBD G v LY c YUM IZ.t.0 iyAr WA STATE CONTRACTOR LICENSE#(REQUIRED):TBD EV t✓ G)(t LTARZCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3y 0 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Arch"Bo1 CONTACT NAME: CONTACT PHONE:541-728-1747 Melissa Martorano CONTACT EMAIL:mmartorano@waremalcomb.com MECHANIC PERMIT INFORMATION VALUATION OF WORK: $` E ,A SSOCIATED PERMIT#(if applicable): - 0 6 (Valuation shall include the prevailing fair marke value of all labor,materials,and equipment needed to complete the work,whether actually paid or n BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure DESCRIPTION OF WORK: THE SCOPE OF THIS PROJECT IS 2ND GENERATION INTERIOR OFFICE IMPROVEMENT CONSISTING OF DEMOLITION,NEW PARTITIONS,MECHANICAL,ELECTRICAL,PLUMBING,MILLWORK,GLAZING AND FINSHES MECHANICAL PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (QtY) NC Unit(attach plan with location of outdoor unit) _Gas Piping-List#of outlets in fixture count 2 Air Handling Unit** Gas Appliance** Boiler(most require backflow prevention)** Gas Fireplace,Insert,and/or Log(*for commercial bldgs) Commercial Refrigeration(Walk-in coolers,VRF,VRV,etc.) Gas-Other(List Type): ** Commercial Ventilation(corridors,stairwell,pressurization,etc.) Heat Pump(attach plan with location of outdoor unit) Compressors/Generators(building permit may be required)** Heat Pump Ductless(attach plan with location of outdoor unit) Clothes Dryer Exhaust Hydronic Piping 2 Duct System(additions,alterations) Unit heater(commercial use) 3 Exhaust Fan(residential or commercial use) I Water Heater(gas or electric) Exhaust Hood(residential over stove) Wood/Pellet Stove or Insert Exhaust Hood Type I *** Other(List Type): Exhaust Hood Type II *** Other(List Type): Furnace(residential) Other(List Type): * For commercial gas fireplaces,please attach plans and manufacturer's installation manual. ** Under Description of Work,please include Type of Equipment,model#'s,ad detailed description of work,and the location of the equipment. Type I hood and Type II hoods shall be on a stand alone Mechanical Permit application and requires plan review.Please submit the required documents as *** described in the associated Checklists online at everettwa.gov/permits under the Checklists&Handouts tab. 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 DIgttley signed by Melissa Martorano PERMIT# Melissa Martorano°N C-US,E-mmarlorano@waremalcomgcom', 04/12/2023 M�30/ — 0 7,6 GN.Melissa Martorano Deb:2023.04.12 1047:04-07'00' Owner/Authorized Agent Signature Date (Revised 4/21/2022)