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Elm <br /> BU )ING PERMIT APPLICATI I <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I (W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 8531 Evergreen Way PARCEL#: 28041300103100 <br /> CITY Everett STATE WA ZIP 98208 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION (if applicable): <br /> TENANT/BUSINESS NAME(if non-residential):Community Health Center of Snohomish County <br /> LEGAL DESCRIPTION for new construction: Short Plat/subdivision: ANF 7801120300 Lot No.: (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:Community Health Center of Snohomish County <br /> OWNER MAILING ADDRESS: STREET 8609 Evergreen Way <br /> CITY Everett STATE WA ZIP 98208 <br /> OWNER PHONE:425.789.3800 OWNER EMAIL: dkapetanov@chcsno.org <br /> CONTRACTOR COMPANY NAME:Aldrich &Associates, INC. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):ALDRIA`202RU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 39375 <br /> CONTRACTOR ADDRESS: STREET810 240 St. SE <br /> CITY Bothell STATE WA ZIP 89021 <br /> CONTRACTOR PHONE:425.483.1919 CONTRACTOR EMAIL:mdaumen@aldrich-assoc.com <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425.823.2244 <br /> Janet L. Monda CONTACT EMAIL:janet@awerks.com Cc: ryan@awerks.com (Ryan O. 'vie) <br /> BUILDING INFORMATION <br /> VALUATION OF WORK:$5 2C�000 N UC7CJ ASSOCIATED LAND USE PROJECT#(if applicable):TBD, <br /> (Valuation shall include the prellifil fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> EXISTING USE OF BUILDING: <br /> PROPOSED USE OF BUILDING:Business, office <br /> HEAT SOURCE: ❑Gas lElectric ❑Other <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: OCommercial ❑Accessory Structure <br /> TYPE OF PROJECT(check all that apply): ONew Construction ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Change of Use <br /> ❑Modular ❑Portable ❑Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure <br /> ❑Fence over 7ft high ❑RackStorage ❑Pool/Hot Tub ❑Tank(above ground) ❑Other: <br /> DESCRIPTION OF WORK:THE PROJECT CONSISTS OF A NEW TWO STORY BUILDING FOR USE AS AN OFFICE BUILDING ON A VACANT SITE. <br /> SITE WORK CONSISTS OF PARTIAL SITE CLEARING AND RE-GRADING,NEW UTILITY SERVICE RUNS AND CONNECTION,EXPANDED PARKING,NEW BUILDING <br /> FOUNDATION,LANDSCAPE AND IRRIGATING,AND SURFACE WATER RUNOFF CONTROL. <br /> BUILDING WORK CONSISTS OF METAL SIDING AND STONE VENEER INSULATED WOOD STUD EXTERIOR WALLS,CONTINUOUSLY INSULATED ROOF,ALUMINUM <br /> STOREFRONT DOORS AND WINDOWS,STEEL AWNINGS,GYP.WALLBOARD METAL STUD WALL PARTITIONS,WOOD MILLWORK,WOOD DOORS,CARPET TILE <br /> FLOORING,ACOUSTIC CEILING PANEL GRID SYSTEM,ELECTRICAL,MECHANICAL,PLUMBING,FIRE-LIFE SAFETY AND FIRE SUPPRESSION SYSTEMS AS REQUIRED <br /> PER ROOM CONFIGURATION. <br /> ELECTRICAL,MECHANICAL,PLUMBING,FIRE-LIFE SAFETY,FIRE ALARM,AND FIRE SUPPRESSION SYSTEMS TO BE BIDDER DESIGNED&SUBMITTED AS A <br /> SEPARATE DEFERRED SUBMITTAL. SIGNAGE AND LOW-VOLTAGE DATA AND SECURITY TO BE BY OWNER'S REPRESENTATIVE&SUBMITTED AS A SEPARATE <br /> DEFERRED SUBMITTAL. <br /> 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 <br /> 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 <br /> 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, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Digitally signed by p p.Ryan 0 Ivie,Janet L.Monda <br /> ON.C=US,E=ryan@awerks.corn,O=Architectural q C O PERMIT# s'f <br /> p.p. Ryan O. Ivie,Janet L. Monda Werks INC.,OU=Architect,CN="p p.Ryan 0!vie, 02/1 6/2023 tl3 / 2 0 � -- 0 <br /> Janet L.Monda" ��// [/,� ./] VV <br /> Date:2023.02.16 07.40-45-08'00' <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br />