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110 • I <br /> PERMIT APPLICATION <br /> ep#406 ...4 <br /> BUILDING I MECHANICAL 1 PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 17# (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (flue or Black ink Only Plonoo) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:1700-13th Street, Everett,WA 98201 PROPERTY TAX#:00438524702102 <br /> .... , <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I <br /> CONTACT INFORMATION <br /> ... .. <br /> OWNER NAME: Providence Health&Services-Washington TENANT BUSINESS NAME(Commercial): Providence Regional Medical Canter Everett <br /> OWNER MAILING ADDRESS: STREET 1321 Colby Avenue <br /> crry Everett sTATE WA zip 98201 <br /> i <br /> OWNER PHONE: 425.261.4558 OWNER EMAIL:davkl.wachob@providence.org <br /> CONTRACTOR NAME))/ea 4\1A- <br /> CONTRACTOR ADDRESS: SWEET i <br /> CITY STATE ZIP <br /> 1 . T <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE tf(REQUIRED): c_Ct 0 s.)( I)Tv OF EVERETT BUSINESS LICENSE#(REOUIRED}: <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR El OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:425-259-0868 <br /> Davin Saylor, AlA CONTACT EMAIL:devin@bnharCh.COM <br /> BUILDING INFORMATION .!. <br /> Existing Use of Buildinj Hospital I-2 Contract Price of Work:$499,593.00(Plan Review$2,101.94) , <br /> Proposed Use of Building: Hospital 1-2 Heat Source: OGas DElectric Daher _ I <br /> BUILDING USE; OSER OTownhouse ODuplex OADU OMulti-Family-#Units: DCommercial OAccessory Structure I <br /> Type of Project: ONew OAddition IZiRemodel ORepair EIT.I OSign OSprinkler ODemolition DChange of Use <br /> DESCRIPTION OF WORK: Tenant Improvement remodel project in existing shell space CT Room 1 for the installation of the <br /> relocated GE CT unit and ceiling suspended patient rail lift system. 1, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> t <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION t <br /> Fixture Fixture Fixture <br /> count , List of Fixtures Fcixot: List of Fixtures List of Fixtures List of Fixtures <br /> Count Count <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) i <br /> i <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,ber) <br /> . ,Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet i <br /> ( <br /> - , <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> • <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential, Wood Stove Interceptor-Sand/011 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/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: I <br /> r <br /> Water Suppression System No.of Heads <br /> 'Chemical Suppression System 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,lain the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Slate Contractors Law 18.27 RCW and 296.200A WAG. <br /> City of Everett Official Ilse Only -, <br /> I/7 e/II PEliC(. 2 .-02-- i <br /> I <br /> i -1 <br /> Owner/Authorized ant Signature ate (Revised 0/10/2018) <br /> i <br />