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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> I OD 1,3414 94- A-Jd- O A <br /> SITE ADDRESS:916 Pactfi -Ave-Evefett,_WA 98201 PROPERTY Tax#00438524702102 PERMIT# <br /> iP 1Soy_o t 5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Providence Health & Services Phone/E-mail <br /> Address 1801 Lind Ave SW Suite 9016 City/State/Zip Renton, WA 98057 <br /> APPLICANT:u Owner 1__l Owners Agent 14_Contractor u Contractor's Agent I 'Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Hermanson Company State Lic.# HERMACLOO5BJ City Bus. Lic.# 037262 <br /> Address 1221 2nd Ave N Kent, WA 98032 Phone/Email 206-575-9700 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Jenni Gregg <br /> Phone/E-mail 2064452897 jgregg@hermanson.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building GasE Electric❑ Other.❑ <br /> Building type: ❑Single Family IL DurptlfixOTownhouse I r I Multi-Family IL Commercial <br /> Type of project: Fl New n Addition Remodel [1 Repair 71,T.I.n Sign nSprinklerri Demolition❑Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Installation of medical gas outlets: (5) MV, (4) MA, (2) N20, (5) 02, and (1) WAGD <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project:INewuAddn uAlteration Lepair Type of Project:❑NewnAddn 71Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other 17 Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �:��•� // ff- <br /> Ow i 'g• t , ature Date (Revised 9/2014) <br />