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PERMIT APPLICATIO <br />BUILDINAECHANICAL / PLUMBING / SIGN MPRINKLER / DEMOLITION <br />EVERETT CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />WASHINGTON (P)425-257-8810 1 FAX425-257-8857 1(E)everetteps@everettwa.govI www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 1321 Colby Avenue, Everett <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal d Ion <br />CONTACT INFORMATION <br />OWNER NAME: Providence Health & Services TENANT BUSINESS NAME (Comme(ial): rj <br />OWNER MAILING ADDRESS: STREET 1321 Colby Avenue <br />CITY Everett STATE WA z,P 98201 <br />OWNER PHONE: 425 - 218-0919 <br />OWNER EMAIL: <br />CONTRACTOR NAME: Providence Health & Services <br />CONTRACTOR ADDRESS: STREET 1321 Colby Avenue <br />crn, Everett STATE WA ZIP 98201 <br />CONTRACTOR PHONE: 425-261-3746 <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR El OTHER (Please Specify) <br />CONTACT NAME: <br />Devin Saylor <br />CONTACT PHONE: 425-259-0868 <br />CONTACT EMAIL: devin@b ch.COn1 <br />BUILDING INFORMATI <br />Existing Use of Building: Hospital (1-A Occupancy) <br />Contract Pric of Work: $'t2P <br />Proposed Use of Building: Hospital <br />Heat Source: as []Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ✓ Commercial ElAccessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓ T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />Minor remodel of existing vacated hospital space to relocate existing microbiology equipment into. <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Sho , ub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Ink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type I <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Re ential) <br />Wood Stove <br />Interceptor-Sa il <br />Water Service (behind meter) <br />Forced Air Sy ms <br />Other: <br />Medical C39d <br />Water Valves or Fixtures <br />Gas Firepl a/Insert/Log <br />Roof ains <br />Water Heater <br />SPRIN <br />ER / SUPPRESSION <br />SYSTEM <br />se11 <br />wage Ejector or Sump Pump <br />Other: <br />Water Suppres n System <br />I <br />lNo. of Heads <br />Chemical Suppression System <br />I <br />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. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />��Cityof Everett Official Use Only <br />PE IT #� <br />(Revised 1011012018) 1 <br />Z <br />