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grrPERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ee 1 ret,WA 98201 Q PROPERTY TAX M.00438524702102 <br /> (31-t cotLvLEGAL for new construction: Short Plat/subdivision t (.et/d 1i Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Health and Services-Washington TENANT BUSINESS NAME(Commercial): Providence Regional Medical Center Everett <br /> OWNER MAILING ADDRESS: STREET 1321 Colby Ave <br /> cnTY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 42 61- 63 OWNER EMAIL:james.grafton@providence.org <br /> CONTRACTOR NA :TBD <br /> CONTRACTOR ADD SS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-261-4563 <br /> James Grafton CONTACT EMAIL:james.graftont>•rovidenc- org <br /> BUI 0:0 A ION _ <br /> Existing Use of Building:hospital(former surgery suite) Contract Price of Wo :$t.7s , to <br /> Proposed Use of Building:hospital Heat Source: DGa"'❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: 1JCor ercial ❑Accessory Structure <br /> Type of Project: New ❑Addition ❑✓Remodel ❑Repair ❑T.l. ElSign ❑Sprinkler &Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Construction of new pharmacy and corridor within space formerly used as Surgery <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL-PERMIT APPLICAT •N::. PLUMBING.PERMIT APPLICATION <br /> Fixture I Fixture Fixture I Fixture <br /> Count List of Fixtures count st of Fixtures Count List of Fixtures Count List of Fi res <br /> A/C—Air Handling Units as Piping Backflow Preventer(Inside Bldg) Shower,T , r Combo <br /> Boiler Gas Range Clothes Washer Sink- mmercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher nk-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residentia Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Typ: I) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(- sidential) Wood Stove Interceptor-Sand/0i Water Service(behind meter) <br /> Forced Air S >ems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fire. =ce/Insert/Log Roof Drai Water Heater <br /> SPRINKLER:/SUPPRESSION SYSTEM; Se ge Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Con rectors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 0-10 <br /> mer Autho i d Agent Signature Date (Revised 10/10/2018) <br />