5130 EVERGREEN WAY COMMUNITY MEDICAL SERVICES 2025-05-09

PL 'JIBING PERMIT APPLICA' )N EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON 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: TENANT/BUSINESS NAME(if non-residential):CMS(Community Medical Services) CONTACT INFORMATION OWNER NAME:Todd Stingley OWNER MAILING ADDRESS: STREET8444 N 90th Street Suite 100 CITY Scottsdale STATE Arizona zip 85258 OWNER PHONE:602-248-8886 OWNER EMAIL:todd.stingley@crosgivehope.com CONTRACTOR COMPANY NAME: `;.,L ` ,,, vp WA STATE CONTRACTOR LICENSE#(REQUIRED):, .Ci t-l".1. 7vsLP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 309--// CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Arcniteci CONTACT NAME: CONTACT PHONE:541-728-1747 Melissa Martorano CONTACT EMAIL:mmartorano@waremalcomb.com PLUMBING PERMIT INFORMATION VALUATION OF WORK: $430,000(FOR ALL CONSTRUCTION) ASSOCIATED PERMIT#(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.) 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. PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (CRY) (QtY) Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service: ❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) Clothes Washer Residential Sink(kitchen,bath,bar) Dishwasher t Utility Sink(laundry,mop) Drinking Fountain Toilet Floor Drain Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker t Water Service Line(Behin rieE Grease Interceptor Water Valves/Fixtures Sand/Oil Interceptor i Water Heater-Electric Medical Gas Water Heater-Gas APR 7 Roof Drains Other(List Type): lavatory 1 t ?�,� -)) Sewage Ejector Pump/Sump Pump Other(List Type): CITY ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done putyant to issRefrn=rinbly with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations muff tEM tabQQlik 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 PERMIT# Melissa Martorano DNzf seMartoranorano@waronalcomb,com", 04/12/2023 r') -36 9 — 0 3 7 Date:2023.04.12 10:47:31 07'00' Owner/Authorized Agent Signature Date (Revised 4/21/2022)