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APPLICATI�.N FOR CONSTRUC'. �ON PERMIT <br /> CITY O� EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION f� COMBINATION (Xl BUILDING 7 MECHANICAL fl PLuMBING I-1 SIGN <br /> PROJECT ADDRESS <br /> 1410 Broadway Avenue, Everett, WA 98201 <br /> OWNER MPILADORE55 Cltt 21P f'NONE <br /> PROVIDENCE GENERAL MEDICAL CEPdTER PO Box 1147 Everett WA 98201 206-261-2000 <br /> IENRNT IJAILA�DRE55 CITY 21P PNONE <br /> Community Health Center 1410 Droadway Avenue, Everett, lJA 98201 258-4595 <br /> nRCHITLCTOR0E5IGNER MAILPD�RE°5 GIiY IIP PMONE <br /> Connell Design 22000 64th Ave. W. Suite 2F Mountlake Terrace, WA 98043 206-670-6706 <br /> GENERALCONRIFCTOR MAILAODPE55 Cliv IIP PHOHE STATEIICENSEM <br /> Carl Larson Construction, Inc. 4d01 76th S.W. Mukilteo, WA 355-4745 CARLLCI160NH <br /> MELNnNILALCONTRACTOP MRILADDRE55 CITV 21P PNONE STATELICENSE� <br /> PLUA�BING CONTRACTOR MAIL AODRESS Cltt ZIP PHONE STATE LICENSE� <br /> GONTRACT PRICE OF WOFR <br /> $50,000.00 HEATING SYSTEM: P�l GAS ❑E�ECT�iIC ❑ <br /> DES BE WOR AryD SOUARE F00T GE INV LV CONiACT FERSON ANO PMONE NO. <br /> `�enan� improvemn�s a� �5°,000 sq ft Barbara Lindsey, Property Management _ <br /> 261-2646 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROI'OSEDUSE Of BUILDING pROVISIONS OF LAWS AND ORD(NANCES GOVERNING THIS TYPE OF <br /> Medical Off iCe s ace WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAlDESCQIPTIONOFPROPENTY(SIIOWNBE�OIYORA7TACNTWOCOPIES) NOT. THE GPAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi 1�'24 BLOCK�_oF Niltpn'c AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> Addi ti on i n the �'I ty of Everett as per pat OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCT�ON.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> recorAed 111 Volume 8 of Plats, page 2. APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBEH CONTRACTORS LAW 1827 flCW AND 296200 WAC. <br /> CONSTRUCTIDNLORNL£NOER,AUDRESS.1ElEPHONENUMBER 1 ///'ii�Y7�//. � �1�+�-�- ys`� �/�r <br /> SIG R7�H�E� ORTE <br /> CIN BUSINE55 LIGENSE N0. <br /> PLUMB�N6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR IiEM FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB � FORCE�AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—O.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> OISHWASIIER � VENTILATION FAN ' <br /> LAUNDRYTRAY ; RANGEHOOD i <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNI'AIN i METAL FIFEPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ; <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING ' <br /> ; EXHAUSTFAN � <br /> � ' <br /> � ; <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S i PERMIT S � <br /> TOTALFEE 5 � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: � O �'Z� �C �� — � l�l� � �� ' � <br /> FRONTSETAACN REARSETBRGN SIOESETBRCK PIANCHECK MOF.R FEE �� /J� RECEIPTNO.� <br /> 7 ii � <br /> G- <br /> USE20NE LO7AREA VACANTSITE FEES VALUATION FEE <br /> IlVES ❑ NO gUILDINd � �/D { .� � <br /> MEI6HTLIMITATIDN NO.OFDWEWNG SIZEOFBLDGITI. � <br /> UNITS IID i/1A�'��( �� p�UM01NG <br /> i <br /> �V KY��[i <br /> OCCUPANCY NOAi5i0PIE5 OCCUPRNTLOAD 9ASEMENT MECHANILAL i <br /> GROUf�� I I� I,. <br /> ��L � M! VTi ❑YES �(NO � <br /> FIREALARMREO'0 REASON A�DIPONALPLANCHECK i <br /> . �` i <br /> /w OTi�ER I <br /> FIRE SPRINKLER RED'D REASON �,� <br /> �y* STRTE OUILDING SURCMARGE � <br /> /VV <br /> TVPE OF CONST PLANS APPROVE�PV � <br /> I CITY OF EVERETT �UBLIC\YORKS I <br /> '7tt i vM LOCAL SALES � <br /> `w�� st. 7 TAX CODE IS 3105 ?OTAL � ��� <br /> DATE <br />