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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: 'PROPERTY TAX# PIMIT# � � <br /> 1800 -41st St., Everett, WA 98203 �VV\\ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER The Everett Clinic Phone/E-mail <br /> Address 1800 -41st St. City/State/Zip Everett, WA 98203 <br /> APPLICANT:_Owner _Owners Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR D.K. Systems, Inc. - DKSYSI*982L1 L&I Lic.# 030,428-00 COE Bus.Lic.#049744 <br /> Address PO Box 886, Burlington, WA 98233 Phone/Email 360-755-1555 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Kevin Korthuis 360-770-7981 <br /> The Everett Clinic-Admin Phone/E-mail kevin@dksystemsiin}c.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $$eE.g( ( coo,`o <br /> Existing Use of Building Medical Administration Bldg HEAT SOURCE: <br /> Proposed Use of Building Medical Administration Bldg Gas_ Electric Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family X Commercial <br /> Type of project: _New Addition _Remodel _Repair X T.I. Sign_Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Duct Work ( `o� std 1S`V efS <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—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 /> X _ 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 complied <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/Authorized Agent Signature Date <br /> (Revised 6/2012) <br />