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� • <br />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 # P IT # <br />916 Pacific Avenue, Everett, WA 98201 29053000200100 �f � I' — UC) <br />LEGAL for new construction: Short PlaUsubdivision See BttaCh2d deSCflpt1011 Lot No. (attach copy of long legal description) <br />OWNER Fairfax Hosqital Phone/E-mail ron.escarda@uhsinc.com <br />10200 NE 132nd Street <br />City/State/Zip Kirkland, WA 98034 <br />CANT: _ Owner _ Owner's Agent X COf1tf8CtOf _ COf1Yf8CYOf S A9Qf1Y _ TBf78fli (must provide a letter o( consent from lhe owner to do work in the space) <br />CONTRACTOR <br />5005 Third Avenue South Seattle, WA 98134 <br />Fairfax Hospital <br />BUILDING PERMIT APPLICATION <br />L & I Lic. # <br />I Phone/Email 206.762.3311 <br />ONTACT FOR PERMIT <br />Brett Sontra 206.786.6002 <br />ione/E-mail bretts(a�mckinstrv.com <br />PRICE OF WORK <br />B�S. ���. # y � aa <br />Existing Use of Building Sleep Therapy Unit HEAT SOURCE: <br />Proposed Use of Building Acute Care Facility Gas Electric X 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 />To selectively demolish existing finishes and construct new architectural finishes within the existing floor plan to support a <br />new 30-patient bed facility for behavioral health patients. <br />� ; ___�_�`,.. i� - .- �% �� <br />ECHANICAL PERM�T APPLICATION <br />of Project: �i�le�Addn-._Alteration _Repair <br />Show Number (#) of fixfures <br />1 A/C - air handling units <br />Forced air systems <br />Gas piping <br />1 Water heater <br />Gas fire�lace <br />2 � Clothes dryer <br />Range hood <br />� Exhaust fan <br />1 Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Ducting <br />29 Other Induction Units <br />IKLER / SUPPRESSION SYSTEM <br />PLUMBING P MIT APPLICATION <br />of Project: N Addn _Alteration _Repai• <br />�—� how Number (#) of fixtures <br />18 Toilet <br />Bathtub <br />2g Lavatory (wash,b sin) <br />16 � Shower <br />� Kitc��k d� disposal <br />`Dishwasher <br />2 CJo'thes washer F <br />'Nater heater <br />Sink (service/bar/mop/etc <br />� Backflow preventer <br />Urinal <br />� Drinking Founta�, <br />2 Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />IOther: <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 />�i� � �� �-��""`'- 1.,: �, , � 7_ <br />Owner/Authorized gent Signature Date <br />(Revised 6/2012) <br />