3726 BROADWAY CONCENTRA URGENT CARE 2025-04-24

B' .DING PERMIT APPLICAT 'N 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 3726 Broadway PARCEL#: Suite 101 -2699198/Suite 104 -0008748 crry Everett STATE WA ZIP 98201 SUITE/UNIT#: 101 a 104 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION (if applicable): TENANT/BUSINESS NAME(if non-residential):Concentra LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No.: (attach copy of long legal description) CONTACT INFORMATION • OWNER NAME:Concentra-Mike Bryant OWNER MAILING ADDRESS: STREET 30800 Telegraph Road CITY Bingham Farms STATE MI ZIP 48025 OWNER PHONE:949-237-8370 OWNER EMAIL: MicBryant@concentra.com CONTRACTOR COMPANY NAME:TBD M i -€ct,t o co V)s Iy r VIVA ' 01c) WA STATE CONTRACTOR LICENSE#(REQUIRED):OOLl14T C-r1 81-0(.0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ( / 05 7 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ✓❑OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:704-561-3243 Rebecca Bailey CONTACT EMAIL:rebecca.bailey@littleonline.com BUILDING INFORMATION VALUATION OF WORK: $487,500 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:Business medical clinic PROPOSED USE OF BUILDING:Business medical clinic HEAT SOURCE: ❑✓Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ElCommercial ❑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 project is the renovation and expansion of an existing clinic to upgrade services by providing better patient and staff flow, improved work space, along with upgrading company standards for millwork, equipment and finishes. 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 <J /:_'Q Digitally signed by Rebecca Bailey PERMIT# /�v� Date:2022.06.22 16:04:44-04'00' 6/22/2022 2-2-0(t) - 0 Fa- Owner/Authorized Agent Signature Date (Revised 4/21/2022)