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PERMIT APPLICATIO'
<br /> BUILDIN&J-IIIIECHANICAL/ PLUMBING /SIGN J 111211INKLER/ DEMOLITION
<br /> #111111PAICITY
<br /> OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue;or,Bla010,4 Only Please)". .. P. :`,' ,P4 OJE0TAR`E`zINFORM ►TlO F * 3, F . .
<br /> PROJECT SITE ADDRESS: 4201 Rucker Avenue, Everett,WA 98203 PROPERTY TAX#: 00582202200101,00582202200202
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: Community Health Center of Snohomish CountyTENANT NAME(If Commercial):Community Health Ctr. of Snoho. Count)
<br /> OWNER MAILING ADDRESS: STREET 8609 Evergreen Way
<br /> CITY Everett STATE WA Z P 98208
<br /> OWNER PHONE: 425789-3700 OWNER EMAIL: DKapetanov@chcsno.org
<br /> CONTRACTOR NAME: To Be Determined 3,-g, ,4/J ,/ -
<br /> CONTRACTOR ADDRESS: STREET VOA Cyt— Atte 5tL le)1
<br /> CIN dere STATE OA ZIP 78131
<br /> CONTRACTOR PHONE: Za(p-4(47 ,5'5-00 CONTRACTOR EMAIL: rli) e Age-c,945yntc-f ipg,e oil,
<br /> CONTRACTOR LICENSE#(REQUIRED): 3t3-dgl36 f 0 Z Z 52- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0/6/52-
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<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR El OTHER(Please Specify) Architect
<br /> CONTACT NAME Janet Monda CONTACT PHONE: 425-823-2244
<br /> CONTACT EMAIL: janet@aWerkS.Com
<br /> Existing Use of Building: Business Office Contract Price of Work:$ 2,709,410.00
<br /> Proposed Use of Building: Medical Clinic&Office Heat Source: ❑Gas %Electric ❑Other
<br /> T
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition %Remodel ❑Repair CIT.!. ❑Sign OSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: The project consists of a remodel to an existing office building for use as a medical clinic and office space.Site work to include
<br /> demolition of one driveway,partial sidewalk and some landscaping.New site work to include partial new sidewalk,some parking re-striping and relocation of
<br /> existing generator to new pad.Structural work to include seismic upgrade to building. Interior renovations to include removal of interior partitions,plumbing,
<br /> lighting and finishes.New work to include metal stud walls,casework,new ceiling systems,lighting,and finishes.New electrical,mechanical,and plumbing
<br /> systems and modifications to fire-life safety and fire suppression systems as required by new work.Electrical,mechanical,plumbing,fire-life safety and fire
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): suppression systems to be bidder designed and deferred permit.
<br /> MECHAN1d L-PERMFTAPPLiC ►1'lON.` V wM ` LUMB N PERMIT 1PPLlC%i#0
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> Chemical or Water I No.of Heads
<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.lam the owner,or/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 Oficial Use Only
<br /> �' TJ /4A) Nvv (c�j i ml (AcL) PERMIT#
<br /> Ow er/ thorized Agent Signature Date (Revised 9/23/2016)
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