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� _ __ � <br />— g <br />PERMIT APPLICATION <br />CITY OF CVERETT PERMIT' S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-gg10 -� FAX 425-257-8857 - vnvw.everettwa.org <br />APPLICATIO�JS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS SUIT'G 'A' <br />4225 Ho t Ave. EvereCt WA <br />LEGA LOT NO. BLOCK <br />oesc. 2�3�4, & 7 021 <br />OWNER <br />[destern [dash. Pledical Croup <br />TENANTNAME <br />Same as owner <br />(haner Contr�ct��r. <br />CONTR. LICENSE p <br />USE OF BUILDING <br />Medical Clinic <br />PAf ���EL TAX I.D. # <br />005C22G210U200 <br />TRACT OR SUBDIVISIQN p <br />South I'ar.k Addition <br />4225 I;oyt Ave., Suite 'A', <br />CONTACT FOR PERMIT <br />Ryan ELlingh3iis <br />Gar.y Parkinson �rchitects <br />HEATSOURCE <br />_ Electric X Gas`Other <br />Gverett, I]A <br />PHONE <br />I �-2-D– <br />PERMIT # <br />i1�yo� - o�� <br />"'-425-259-3122 <br />98203-3251 <br />425-252-2153 <br />CONTRACT P�ICE OF WORK <br />$2C,000 <br />WORK DESCRIPTION <br />Con:;tructi-on of new laboratory in exi.stin� x-ray & storape room. lncludes new extezior <br />r:r��r, ne�o caalls and 1-hour door. Alsr. include scxne ceiling caork and installation of <br />n��o ventilation hoorl <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />_ Lavalory (wash basia) <br />Shower <br />_ Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />_ Water heater <br />Sink (service/barlmop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />O�her <br />NO. J TYPE OF FIXTURE OH ITEM <br />A/G — air handling units <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas tirepiace <br />Gas range <br />Clothes dryer <br />Rar.ge hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOC.' L 6ALES TAX CODE IS 3105 <br />f hereby ceritily that I have read and examined Ihis application and know ihe same lo be irue and wrrect. All provisions of laws and <br />erdinaces'goveming this rype ol work will be complied wiUi whether specitied herein or nut. The gian�ing oi a permit does not presume <br />io give authority lo violate or cancel ihe provision of any other slate or local law regulaling conslmction or ihe perlormance ol <br />conslruction,That I am authorized t�y the owner ol lhis property to perform ihe work lor which application is made and I cemply wilh �he <br />S�ate Contraclors Law 78.27 RCW�and 29G.200 WAQ <br />�� `'�,i �; ir- l_.� �. (i'C/�, c: ,,`- l� S��l <br />Signa dreoi wnedContraclodAuthorized � ent Date <br />Ryanl ,llinghaus, Gar�� Pe�'inson ,lrchitects �/� <br />