10521 19TH AVE SE CASCADE RETINA OPTHALMOLOGY CLINIC 2024-11-07

BUSING PERMIT APPLICATIO EVERETT�(, CITY OF EVERETT PERMIT SERVICES 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 lnk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 10521 19th Ave SE PARCEL#: 280520.002-030-00 crry Everett STATE WA ZIP 98208 SUITE/UNIT#: 106 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Cascade Retina Opthalmology Clinic LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: ,� .•• {I\/ci \) CONTACT INFORMATION OWNER NAME: 44 t_cD 'T=t.=StS JUL 1 5 2023 J OWNER MAILING ADDRESS: STREET 10524 1114 A.,s s= , s 2- o CITY OF EVERETT CITY sv_V2-411‘. STATE Wk. Permit Sswiies OWNER PHONE: 47-S.LIST-.%SSD OWNER EMAIL: CONTRACTOR COMPANY NAME:HST Construction, Inc. WA STATE CONTRACTOR LICENSE#(REQUIRED):HSTCOCI920KA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 050794 CONTRACTOR ADDRESS: meet.11512 NE 20th Street ciry Bellevue STATE WA ZIP 98058 CONTRACTOR PHONE:425-455-1212 CONTRACTOR EMAIL:nigelstarr@hstconstruction.com PRIMARY CONTACT: C7 OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:206-992-7453 Kate Cudney CONTACT EMAIL: kate@hingestudio.net BUILDING INFORMATION VALUATION OF WORK:$496,920 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:NA-Initial TI of shell building PROPOSED USE OF BUILDING:non-surgical medical office HEAT SOURCE: ❑Gas ❑✓Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ElCommercial DAccessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition DRemodel ❑Repair ❑✓T.I. ❑Change of Use ❑Modular DPortable ❑Re-roof DExterior Alteration DTank(above ground) DAccessory Structure ❑Fence over 7ft high DRackStorage DPool/Hot Tub ❑Tank(above ground) ❑Other: DESCRIPTION OF WORK:THE CONSTRUCTION OF A RETINAL OPTHALMOLOGY CLINIC TENANT IMPROVEMENT, INSIDE AN EXISTING BUILDING. THIS IS THE FIRST TENANT IMPROVEMENT IN THE SPACE. THE PROJECT SCOPE DOES NOT EXTEND BEYOND THE BOUNDARY OF THE TENANT SUITE AND DOES NOT ENTAIL MODIFICATION OF THE EXISTING ENVELOPE. 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 lam 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 Z(..)/1Z-707/20/2023 PERMIT# a23 _ 051 u/Gd Owner/Authorsent Signature Date (Revised 4/21/2022)