9930 EVERGREEN WAY THERAPEUTIC HEALTH SERVICES 2026-05-01

BUILDING PERMIT APPLICATION 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)426.257,8810 1(E)everetteps@everettwa.gov I(W)everettwa,gov/permits (Blue or Block Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 9930 Evergreen Way PARCEL#: ciTy Everett STATE WA z P 96204 SUITEIUNIT#: Z150 FLOOR M Roof ADDITIONAL LOCATION INFORMATION(if applicable): TENANTIBUSINESS NAME(if non-residential):Therapeutic Health Services LEGAL DESCRIPTION for new construction: Short Plat/subdivision: Lot No,: (attach Copy of long legal description) CONTACT INFORMATION OWNER NAME:Patricia Edmond-Quinn OWNER MAILING ADDRESS: STREET 5802 Rainer Ave South CITY Seattle STATE WA ZIP 98118 OWNER PHONE:4253889906 OWNER EMAIL: PatriciaEQ@ths-wa.org CONTRACTOR COMPANY NAME:Four Seasons Roofing WA STATE CONTRACTOR LICENSE#(REQUIRED):FOURSRS016QA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 36927 CONTRACTOR ADDRESS: sTREaT 17903 SR 9 SE miry Snohomish sTATE WA zta 98296 CONTRACTOR PHONE:(425)388-9906 1CONTRACTOR EMAIL:tiana@fourseasonsroofing.com PRIMARY CONTACT: ©OWNER Z CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(425)388-9906 Tiana Brown CONTACT EMAIL:tiana@fourseasonsroof.com BUILDING INFORMATION VALUATION OF WORK:$178930 ASSOCIATED LAND USE PROJECT# if a Ilcable : Railuallon shall n u e the provalling takMarket value of all labar,materials,and a ul ment needed neaded to mom late the work,whether aclual aia or not.) EXISTING USE OF BUILDING:Commercial PROPOSED USE OF BUILDING:Commercial-no change HEAT SOURCE: []Gas ❑Electric ❑Other BUILDING TYPE: ❑SFR ❑Townhouse L]Duplex ❑ADU CIMAI-Family-#Units: ElCommerclal ❑Accessory Structure TYPE OF PROJECT(check all that apply): ❑New Construction ❑Addition ❑Remodel C Repalr 11T.1. ❑Change of Use ❑Modular ❑Portable C+r=1Re-roof ❑Exterior Alteration ❑Tank(above ground) ❑Accessory Structure ❑Fence over 7ft high ❑RackStorage ❑PoollHot Tub ClTank(above ground) ❑Other: DESCRIPTION OF WORK: Remove existing roofing to roof deck, provide new underlayment and asphalt shingles. ACKNOWLEDGEMENT.,1 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, end I comply with the State Contractors Lew 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# O 71ana Cooper o21AY�1ao, 3/tb/2ti L OwnerlAuthorired Agent Signature Date (Revised 2/8/2021)