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PEP.MIT APPLICATION <br /> BUILDII�GIMECHANICAI.IPLIf MBINGISIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar SL, Everett,WA 98207 -425-257-8810-FAX 425-257-8857-www.everettw org <br /> APPUCAS�tONS ARE ACCEPTE�FROM 8 AM TO 4 PM J �D"'�� <br /> SITEADDRESS: v�$DE�r��x�46 OOD 00 MITa <br /> 1321 COLBY AVENUG O <br /> LEGAL lor newmrtrucinn-. Shotl PiaU.ubdiv�son lot No._ (atlach eepyol lo�g leqal de,cnpLon� <br /> OWNER F'ROVIDENCE EVERETT M�llICAL Pnone�Ema�l <br /> Aderess 916 PACIFIC AVE Cdy/State2ip EVERET'P, [4A 98206 <br /> CONTRACTOR /Vc� oW.{ (,c i 'iq �c, � L81L�c.d ES OC. <br /> AEdress Phonel[maii <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT �ecky 7cdd, FTS :or :�T�'r <br /> A7'&T h10BILITY zo�-3io-i»3, �codd�.pesw•a.�om <br /> Phone�Email <br /> BUILDING PERMIT APPLICAT�ON CONTRACT PRICE OF WORK 15, 000 <br /> ExistingUseof[3uild�.nghcsp�cal w/ NCF _ HEATSOURCE. <br /> ProposedUseofBuilding ho:;pital w/ wCe GasH��iectrrcN/I'Oiner N/A <br /> Building rype: _Sin91e Family _Duplex_Townhouse _Mulli-Family =Commercial <br /> Type ol projecC _New _Addilion _Remodel _Repair X T.I.__Sign_Sprinkler_Demoldion_Change ol Use <br /> Ue Ij dWOrk addrhonals acepovrdoAon ie ck): <br /> �`'���" i.s p�oposi�ng �o mo�` i�y an existittg facility by adding one (l� new <br /> bal-tery backup unit (RAU) inside an er.isting accessory equipment room. <br /> Have you started working wilhoul a permit7 _YES X NO <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of PrqecC _New_Addn _Alleratlon_Repair Type ol Projecl: _New_Addn _Alleralion,__Repolr <br /> SMaw Numba(p/o!lirfures Show Number(p)al/irfures <br /> NC-air handim unds ToiiM <br /> forced air systems 9alhtub <br /> Gas n�Pinq Lavaloi (wach bas�n) <br /> Waler lica�er Showe� <br /> Gas fireplar,e Kilchen sink 8 disposal <br /> Gasran c Dishwasher <br /> Clolhes A nr Clothes washer <br /> Ran e hood Walen c�atcr <br /> L.ha�isl fan Sink(scrviCcfbarlmople�c ) <br /> Hcat pumo �ack0ow prevenler <br /> Unit hcoter Urinal <br /> [3odr.r Dnnkinq Founlain <br /> Hclri�craiion Floor Ar.nn <br /> VJond•dnvr Grcaselrep <br /> Dur,tinr� Rool drams <br /> Olher Med�c:31 Gas <br /> SPRINKLEft / SUPPRESSION SYSTEM other <br /> INumhcr of Hr;ids Olhcr <br /> 1 hereby cerl�ly Ihal I havc rcad and r.ammed Ilus apphcation and know Ihc;am�e In p�e Inu�and cnrrccl.All pmvrt.mm,ol law;and ord�nances govetmnq <br /> Ihu Iype o��.ork a+l�be cumDl�eC w�Ih whelhcr;pcU��cd hemm or nol.ihe 9�audng of a pc�md doc�,nut Orn;u�re lo yve aulhonly lo rlolale or ca�xel <br /> Ihr p:om;ion nLmy c�her stale or loral I;�w re9ulalmq cr,nstn;cl�on or Ihr.pedormance ol co�;IqiClwn 7ha1 I dm aulhon2ed by Ihe oxnCr ol Ihu propeqy <br /> lo perform the v�rcAlur wlnch appliralion i;mnde ana I romplV�eUi Ihe Stnlo Cnnlraclo,La.v 18 27 RGW anA 276200 WAC <br /> � ;1�-�-C IZl►�t,� <br /> Onn dAulhorized A ni Sigwlurrt Dato (Rnvisnd✓F�]1) I r� <br /> � <br />