206 E CASINO RD DENTAL OFFICE 2025-04-11

BUILOVG PERMIT APPLICATI EIZEINEDEVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: See a licable submittal checklist for submittal re uir is a mtg a of RRR�jj1iies refor review, WASHINGTON then drop off completed application plus all required submittal document 00 ht Strdet i ioor IIDrop Box. CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I(W)everettwa.gov/permi (Blue or Black Ink Only Please) PROJECT SITE INFORMATION CITY Or LVERETT Permit Services PROJECT SITE ADDRESS: STREET 206 E CASINO ROAD PARCEL#: 280413-001-002-00 cITY EVERETT STATE WA ZIP 98208 SUITE/UNIT#: 4 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):EVERETT DENTAL CLINIC LEGAL DESCRIPTION for new construction: Short Plat/subdivision: NA Lot No.: NA (attach copy of long legal description) CONTACT INFORMATION OWNER NAME:CASINO ROAD CENTER LLC OWNER MAILING ADDRESS: STREET 4717 211TH ST SW CITY LYNNWOOD STATE WA ZIP 98036 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:NW BUILDER GROUP LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):NWBUIBG838NP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 63131 CONTRACTOR ADDRESS: STREET 8228 S 206TH ST CITY KENT STATE WA ZIP 98032 CONTRACTOR PHONE:206.507.4308 CONTRACTOR EMAIL:RON@NWBUILDERGROUP.COM PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) ENGINEER CONTACT NAME: CONTACT PHONE:206.340.8118 TIFFANY LA CONTACT EMAIL:TLA@DEGENKOLB.COM BUILDING INFORMATION VALUATION OF WORK:$11,768.00 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:COMMERCIAL PROPOSED USE OF BUILDING:NO CHANGE HEAT SOURCE: ❑Gas ❑Electric ❑✓Other NA BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel ❑✓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:THE SCOPE OF WORK CONSISTS OF THE REMOVAL AND REPLACEMENT OF APPROXIMATELY 7 LINEAR FEET OF EXTERIOR WALL AND BRICK VENEER DUE TO DAMAGE FROM A VEHICLE STRIKE ON THE NORTHWEST SIDE OF SUITE 4. THE REPAIR USES LIKE-KIND MATERIALS TO REPAIR THE DAMAGED COMPONENTS. THE OCCUPANCY OF THE BUILDING IS UNCHANGED. THE EXISTING FOOTPRINT AND UTILITIES REMAIN UNCHANGED. 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 DigTIFFANY LA DNItally C-US E=TLA@DEGENKOLB.COM,signed by TIFFANY LA PERMIT# O=DEGENKOLB ENGINEERS,CN=TIFFANY LA 12/13/2023 Date:2023.12.13 07:19:09-08'00' / Owner/Authorized Agent Signature Date (Revised 4/21/2022)