10217 19TH AVE SE DR SHARMA 2024-11-15

MIN 17.1 BUSING PERMIT APPLICATIc 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 10217 19th Ave. SE PARCEL#: 01020900010100 CITY EV-..-•' STATE WA ZIP 98208 SUITE/UN #: 101 / FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/B S NAME(if non-r• _:.ential , -nue Dental - Dr. Varun Sharma LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:VA REALESTATE, LLC OWNER MAILING ADDRESS: STREET 1 501 7 SE 80TH ST CIS. NEWCASTLE STATE WA ZIP 98059 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:SOUnd Building and Construction WA STATE CONTRACTOR LICENSE#(REQUIRED):SOUNDBC927JQ CITY OF EVERETT BUSINESS LICENSE#(REQUI ED): 66069 ov CONTRACTOR ADDRESS: STREET7527 1 1 7th Pl. CITY Newcastle STATE WA 98056 CONTRACTOR PHONE:425-531-0746 CONTRACTOR EMAIL:jeSSe.buttar@gmall.COm PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Applicant CONTACT NAME: CONTACT PHONE:503-539-3657 Chelsea Rodgers Obsidian Design, LLC CONTACT EMAIL:obsidiandesignpdx@gmail.com BUILDING INFORMATION VALUATION OF WORK: $200,000 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:OfficeS PROPOSED USE OF BUILDING:Dental 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 El 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:NEW DENTAL PRACTICE. ADD NON LOAD-BEARING WALLS, PLUMBING AND CABINETRY. NO CHANGE IN OCCUPANCY. 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.1 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 Contrac Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 06/03/2023 PETS#_ _t Owner/Author' gent ' nature Date (Revised 4/21/2022)