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. � <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.N PF,RMIT#-7 <br /> 900 Pacific Avenue 29053000200300 � � ' / �'� <br /> LEGA �RAC7 Rang� <br /> oeSC. Sec iori Towenes�iip <br /> OWNER ADDRESS CITY2IP PHONE <br /> Providence General Medical Cent�P�Box ' 147 rverett 98206 (4251339-363B _ <br /> TENANT NAME CONTACT FOR PER�11T PHONE <br /> e verett Clinic n n Cl�rk (425)339-5460 <br /> CONTRACTOR AODRESS CIN21P PHONE <br /> Tl�e Everett Clinic 3901 Hoy[ A�•enue I:verett 98201 (425)327-4726 <br /> CONTR.UCENSE/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �Electric Gas Olher �U �� /\ <br /> WORK DESCRIPTION <br /> Minor remodel to an existing medical clinic building. No e;:terior work. lnterior renovation <br /> include removal of non-bearing walls and replacement with stud wall partitions, gypsum board; <br /> millwork, vinyl and carpet flooring, and minor modifications to electrical, mechanical, <br /> and lumbin s ste MECHAIvICAL <br /> PLUMBING <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ NC–air handting units <br /> 9athtub _ Forced air systerns <br /> � Lavatory(wash basin) - _ Gas piping i <br /> Shower J �� ��� r VVater heater <br /> _ Kitchen sink 8 disposal �7�� ��y�! _ Gas 6r=place I <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer ' <br /> Laundry iray _ R3nge hood I, <br /> Sink(service/badmoplelc.) _ 6xhaust fan � <br /> 8ackflow prevanter _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Roiler <br /> Floor drain _ Refrigeration <br /> Grease trap Woo�.stove <br /> — Roof drains =I Other <br /> 1 Other relocated sink <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this apphcalion and know ihe same to be true and correct. All provisions r,i laws and <br /> ordinaces gr,verning this type ol work will be complied with whelher,peciGed herein or not.The graMmg of a permit does nM presume <br /> to give auihority to violale or cancel ihe provision of any other state or local law regulating construction or Me perlortnance of <br /> con ��n. That I am authorized by the ner of this prcperty to pedorm ihe v.ork(or which appGcaGon is made anU I comply with the <br /> ate Con�ractors Law/18 2 VJ and 6 200 WAC. <br /> \�` �!'�-L• ` � l.� �'� /_/ / —C�✓.� <br /> � Si nature o(OwnedContradodAuthonzetl A9ent # Date n/]- �' <br /> I �� <br />