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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> 1321 Colby AveITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: 1321 Colby Ave PROPERTY TAX# 004385246000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Providence Medical Center Phone/E-mail <br /> Address 1700 13th St City/State/Zip Everett, WA 98201 <br /> APPLICANT:UOwner Owner's Agent ZContractor Li Contractor's Agent Urenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR Hermanson Istate Lic.# hermacIOO5bj City Bus. Lic.# 037262 <br /> Address 1221 2nd Ave N Phone/Email 2O657597OO <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Providence Kaylene Nelson <br /> Phone/E-mail 2065759700 kaylene.nelson@hermanson <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK / <br /> Existing Use of Building HEAT SOURCE; <br /> Proposed Use of Building Gas IEiectric Other <br /> Building type: Single FamilyQ Duplex oTownhouse Multi Family ✓ Commercial <br /> T e of project: New Addition Remodel Re air T.I. Sin S rinkler Uemoiition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): n I;, ,_,• w,� a , <br /> connect new Boom for 0t2 9. Outlets covered are part of this boom. Q�1.1?,�,Ar- <br /> � riPuw <br /> MECHANICAL PERMIT AP LICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New ddn DAlteration L6pair Type of Project:ELNe,oAddn ✓ Alteration Repair <br /> Show Number # of fixtures Show Number # of fixtures <br /> A/C—air handlin units Toilet <br /> Forced airs stems 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/mo /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 $ 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 /> Owner) uthorDate (Revised 9/2014) <br /> ized A ent Signature <br />