1717 13TH ST FLOOR 3 EVERETT CLINIC 2021-09-08

PERMIT APPLICATION BUILDING ACHANICAL / PLUMBING / SIGN / *INKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES OL3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 11 I 13 TH ST V E�C—r T PROPERTY TAX#: 0040 g4 Z 3 DOO IO) LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: PQDV 1 DEIJ CE N E L H SMVILfS-w#f-NANT NAME(If Commercial): -fl-4E e\/E7 ET L' (-JlQ►C„ OWNER MAILING ADDRESS: STREET (E501 LJ M J) VE S�N * C)01(0 CITY -R STATE ZIP 901757 OWNER PHONE: 42S- 5 25 1OWNER EMAIL: CONTRACTOR NAME: U N1v E2S(TP M 1-C�}A-rQ i r-A.L W NTY'eAcr D125 1 CONTRACTOR ADDRESS: STREET +A I 1.(p 11 TIA P L W CITY V Vit L L tZ O STATE WA, ZIP 0J 8 -7�/ CONTRACTOR PHONE: 20(x- 3t�A - g Qn CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): U N 1 V MC* 343 N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0Q G-7 Z(c3 PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2-06--75(o- OSI S HENRY 131&&S CONTACT EMAIL: h 6 5 @ L&MCA • Co(VI BUILDING PERMIT APPLICATION Existing Use of Building: (DS - MEDICAL 4 0 HL--M SV Contract Price of Work: $ Proposed Use of Building: ME CA 4 Q'm'E12 N'UTA SVCS Heat Source: Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IRCommercial ❑Industrial Type of Project: El New ❑Addition ❑Remodel ❑Repair KT.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: U PG1Z_A0e To � E-N-r ft pe (USP eQ0). I tJ ST-A LL 3 Te-JZM)W t, U N RS, I DI FRO SERL , A-N D S FLS rJ FI L-TCR- U N I T S. ASSOCIATED BUILDING PERMIT#(if applicable): B I(O D21 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New _ Addn Alteration _Repair Type of Project: New _Addn X Alteration _Repair #of #of #of #of List of Fixtures List of Fixtures List of Fixtures List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood I DIFPQ!5,eT2-SWater Heater Other: Exhaust Fan 3 TC-RMIalAL UNI I Sink(Service/Bar/Mop/etc.) Other: 5 1 FA►J ALTEILUNI r, (sCl2ug 1 EMERG£n1G EYE WA514 SPRINKLER / SUPPRESSION SYSTEM Chemical or Water No. of Heads 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 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 Building Official before being authorized under any circumstance./am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made. and 1 comply vAh tip State Contractors Law 1 J.27 RCW and 29q. -WAC. City of Everett Official Use Only AK CPPERMIT#X. 5/12f i"T n Owner/A t orized A nt ign Date (Revised 9/23/2016)