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� <br />�ERMIT 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 />ITE ADDRESS: PROPERTY TAX # P�t MIT # <br />3305 Nassau Street Everett, WA 98201 00437578600100 �j-1j�7j�� — 0�� <br />GAL for new construction: Short PlaUsubdivision <br />No. (attach copy of long legal description) <br />Washington Center for Pain Management �Phone/E-mail 9'S. � i9 . 1��3e / jae@seatt � epa' nspecia� ist. com <br />2840 116th Ave NE Suite #140 �City/State/Zip Bellevue, WA 98004 <br />APPLICANT: _ Owner x Owner's Agent _ Contractor _ Contractor'S A92�Y _ T8f18f1� (must provide a lelter of consent from the owner to do work in the space) <br />CONTRACTOR Constantine Builder, Inc . L& I Lic. # CnNSTRT9A2,75 COE Bus. Lic. #60218874 <br />ress 18486 Ballinger Way NE Lake Forest, <br />Washington Center for Pain Management <br />BUILDING PERMIT APPLICATION <br />WA 98155 Phone/Email paulc@constantinebuilders . com <br />CONTACT FOR PERMIT <br />Chris Buchanan <br />Phone/E-mail p: 206 . 629 . 3210 e: chrisB@pkjb. com <br />CONTRACT PRICE OF WORK %�(i , O�% U <br />Existing Use of Building Medical Of f ice HEAT SOURCE: <br />ProposedUseofBuilding Medical Office Gas Electric X Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family X Commercial <br />Type of project: New Addition x Remodel Repair x T.I. Sign _Sprinkler x Demolition Change of Use <br />DESCRIPTION OF WORK (additiona/ space provided on the back) : <br />TENANT IMPROVEMENT OF A 3,992 SF MEDICAL OFFICE WITH A TOTAL CONSTRUCTION SCOPE OF (2) <br />PROCEDURAL ROOMS, (5) EXAM ROOMS, OFFICES, WAITING AREA, AND ANCILLARY SPACES. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _ <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />PLUMBING PERMIT APPLICATION <br />Repair Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />Toilet <br />Bathtub <br />Lavatorv (wash basinl <br />rcerngerauon <br />Woodstove <br />Ducting <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />Shower <br />Kitchen sink & dis <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/ <br />Backflow preventE <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />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 296200A WAC. <br />r "� � <br />�' .. � �Z-<< � �3 <br />O r uthor zed Agent Signature Date (Revised 6/2012) <br />