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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: 1800 41st Street Suite S400 PROPERTY TAX# PERMIT <br /> 00620800000002 K( (./- -01 0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Jones Lang Lasalle Phone/E-mail <br /> Address 1800 41st Street Suite S210 City/State/Zip Everett,WA 98203 <br /> CONTRACTOR Reliance Fire Protection L&I Lic.# RELIAFP102L1 0 71 o ? <br /> Address PO Box 428,Preston,WA 98050 Phone/Email 206-482-0672 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> The Everett Clinic - f C-76" '5S kevin@reliancefire.com <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other_ <br /> Building type: Single Family Duplex_Townhouse Multi-Family Commercial <br /> Type of project: New Addition _Remodel Repair_T.I._Sign_Sprinkler Demolition Change of Use <br /> Description of Work(additional space provided on the back): <br /> 14ao P1,:q..ecA—re <br /> Have you started working without a permit? YES NO <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 I 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 /> I Clothes dryer Clothes washer <br /> Range hood ( Water heater <br /> I Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump [ Backflow preventer <br /> Unit heater ; Urinal <br /> Boiler I Drinking Fountain <br /> Refrigeration c Floor drain <br /> Woodstove Grease trap <br /> Ducting f Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> 62 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 <br /> this type of work will be complied with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel <br /> the provision of any other state or local law regulating construction or the performance of construction.That I am authorized by the owner of this property <br /> to perfo m the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> , -.V 3/25AS_ <br /> 0 er/Auth Agent Signature ! Date (Revised 2/2011) <br /> Vz <br />