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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 />ITE ADDRESS: PROPERTY TAX RM T# <br />1321 Colby Avenue Everett, WA 98201 1���`f 3G� �L y�% C��- c:%e:� �� �� �j� --' <br />LEGAL for new construction: Short PlaUsubdivision��R��BLK24F)D-OO-BLK���i �-3Z (attach copy of �ong �ega� description) <br />owNeR Providence, Darren Redick Pno�e,E-ma;,425-258-7812 darren.redick@providence. rg <br />916 Pacific Avenue <br />Owner X pwner's Agent <br />Everett, WA 98206 <br />Contractor _ Contractor�S A92flt _ TBflaflt (must provide a letter of consent 6om the owner to do work in the space) <br />rwacroR Mortenson Construction ,To�y Copl��tate �ic. # <br />14719 NE 29th Place Bellevue, WA 98007 <br />Providence Hospice and Home Care <br />BUILDING PERMIT APPLICATION <br />Bus. ���. # <br />Phone/Email 425-895-9��� Tony.Copley@Mortenson. <br />�NTACT FOR PERMIT Mark Suryan <br />25-463-1572 mark.suryan@mulvannyg2.com <br />ione/E-mail , <br />PRICE OF WORK �Y Z, 3 �' ��, � <br />Existing Use of Building Space not in use HEAT SOURCE: <br />Proposed Use of Building FiOSpIC@ Gas� Eiectric_ Other <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family X Commercial <br />Type of project: New Addition Remodel Repair X T.I. Siqn Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additional space provided on the back): <br />Interior tenant improvement of the 8th floor A-wing PRMCE to a 16 bed Hospice Care Center. <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />Forced air s stems <br />Gas i in <br />Water heater <br />Gas fireplace <br />, Gas range <br />Clothes d er <br />Ran e hood <br />Exhaust fan <br />Heat pump <br />; Unit heater <br />Woodstove <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New _Addn _Alteretion _Repair <br />Show Number (#) of fixtures <br />I Toilet <br />Lavatory (wash basi <br />Shower <br />Kitchen sink & dispc <br />Dishwasher <br />Clothes washer <br />Sink servi� <br />Backflow p <br />Urinal <br />Drinking F� <br />Floor drain <br />Grease tra <br />Medical Gas <br />Other: <br />Other: <br />I hereby certi(y that I have read and examined lhis application and know the same to be true and correct All provisions of laws and ordinances goveming this type of work will be compl <br />with whefher specified herein or not. The granting of a permit does not presume to give authority lo violate or cancel the provision of any other state or local law regulating construction <br />That I a horized by the own r of lhis property to perform the work for which applicafion is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br />l�l�Y� l`� i�,� �� '� .7�; , �S <br />Owaet/Authorized Agent Si ature Date (Revised 9/2014) <br />III <br />� / <br />� �, <br />