3726 BROADWAY CONCENTRA URGENT CARE 2025-04-24

NEN PL -JIBING PERMIT APPLICA' )N EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON 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 cITv Everett STATE WA ZIP 98201 SUITE/UNIT#: 101 &104 FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential):Concentra 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 • (hil CONTRACTOR COMPANY NAME:TBD M l')'r(%�,1 C liSWV/Aion WA STATE CONTRACTOR LICENSE#(REQUIRED): M(M,N)TC g 9-9RO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 yD 5 7 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) aroh1ec1 CONTACT NAME: CONTACT PHONE:704-561-3243 Rebecca Bailey CONTACT EMAIL:rebecca.bailey@littleonline.com PLUMBING PERMIT INFORMATION VALUATION OF WORK:$estimate 75,000 ASSOCIATED PERMIT#(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.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: IZiCommercial ❑Accessory Structure DESCRIPTION OF WORK: Remove all existing plumbing fixtures, cap lines as needed where abandoned. Provide new fixtures, sanitary lines, vents, and water lines as required for project. PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (Qty) Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service: ❑DCDA, Domestic Service: ❑RPBA❑DCVA Commercial Sink(3-compartment, prep,floor) Clothes Washer 21 Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain 7 Toilet Floor Drain Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker Water Service Line(Behind meter, private side) Grease Interceptor 2 Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump Other(List Type): 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 Digitally signed by Rebecca Bailey PERMIT# 06/22/2022 Date:2022.06.22 16:41:31 -04'00' \). / W `e O11- Owner/Authorized Agent Signature Date (Revised 4/21/2022)