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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, W w <br /> 98201 425-257-8810 FAX 425-257-8857 ww.everettwa.org <br /> 1dl1 ,3-r-i,- -r <br /> SITE ADDRESS: 1321 Avenin PROPERTY TAX# See attached PFR IT ar\�_O�� <br /> IC B 5 V <br /> see attacnea <br /> LEGAL for new construction: Short Plat/subdivision D e S C . Lot No. (attach copy of long legal description) <br /> OWNER Providence Regional Medical Center Phone/E-mail (425) 261-2000 <br /> Address 1700 13th Street City/State/Zip Everett, WA 98206 <br /> APPLICANT:_Owner X Owner's Agent Contractor _Contractor's Agent Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Mortenson Construction State Lic.# 706,089-00-0 City Bus. Lic.# 021465 <br /> Tony Copley 425-736-4343 <br /> Address 10230 NE Points Drive #300, Kirkland, WA 98033 Phone/Email tony.copley@mortenson.com <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Providence Regional Medical Center Rick Ullman 206-521-3510 <br /> Phone/E-mail rick.ullman@zgf.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $461,000 <br /> Existing Use of Building Hospital HEAT SOURCE: <br /> Proposed Use of Building Hospital Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New _Addition X Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Build out shell space in Interventional Radiology area to create one new <br /> finished & furnished imaging Procedure Room (F3206), and modify <br /> existing clean core room (E3202) to add power and data outlets for <br /> equipment. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration_Repair Type of Project: New Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> ( Unit heater ! Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> I Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> II <br /> 1 Number of Heads i Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> Thauthor d by t -o . this property to perform t - 'ork o , h application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ��, 7-21-15 i Owner/A thorized Agent Signature Date (Revised 4/2015) <br />