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0 PERMIT APPLICATIOS <br /> 1121 <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (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:1321 Colby Avenue PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> = CONTACT INFORMATION ____.____} <br /> OWNER NAME: Providence Health &Services TENANT BUSINESS NAME(Commercial) TV <br /> OWNER MAILING ADDRESS: STREET 1321 Colby Avenue <br /> cry Everett STATE WA zip 98201 <br /> OWNER PHONE: 425-218-0919 OWNER EMAIL:James.Grafton@providence.org <br /> CONTRACTOR NAME: TO BE DETERMINED -0._e_`S i. ( 1.c tok.A.) <br /> CONTRACTOR ADDRESS: STREET -3 g j 4 A-((L eO fL-T b ^�c�\. n 7 <br /> CITY RgLc.1 P� ii-k. STATE J ZIP 91 2 <br /> CONTRACTOR PHONE: 360 - 34-3 6 DO ' T CONTRACTOR EMAIL:t•L-MA 4.Xi�� 4/4-kSt�a64440ytQ cam, <br /> CONTRACTOR LICENSE#(REQUIRED): j Q 1�a: - ?L)O 133- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): s`og5 y <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-259-0868 <br /> Devin Saylor CONTACT EMAIL: devin@bnharch.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Hospital Contract Price of Work:$20,000.00 <br /> Proposed Use of Building: Hospital Heat Source: DGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remodel (2)existing toilet rooms on the 4th Floor B Wing. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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.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 Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3-15-2021 PIS ©) op d <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />