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k�� <br /> r �" , <br /> APPLICaT1ON FO�i COWSTRJCTIAN <br /> PERMIT <br /> f^.o 6�orgreen rvrrrll <br /> CI7 V OF � <br /> everett <br /> BUILDING DEPARTMENT �I <br /> �� �j 259-8870 TO BE COMPLETED IN INK— PLEASE PRINT -- <br /> 7tl y <br /> ow'r.ca r.�ainor.�tss cnr zi�• �,�om� <br /> � y y Genera� Hospital Medical Center _1321 Colby Ave. Ever�tt 98201 258-6300 <br /> iENAld MPILAD�R[55 CIiY ZIP PIIONE <br /> y�~ CI1V ZIP PIIONE . <br /> F� H � AqCInIEG10R0E5i8M1ER ��+IL�OORE55 <br /> o x o L•'ood Service Design/Owner 1321 Colby Ave. Fverett 98201 <br /> � H � GENiR1lCOf1IP/.C10R C>ILfOD�[55 G�IY ZIP FIIOYC UGENSE• <br /> H � ~ Sellen Con. 22II 9th Ave. N. Seattle, WA 98109 682-7000 SEliLEC*372N0 <br /> � �' � �+EdMANiULGONtRAGTOR MAllA00RE55 CI1Y IiP 1'NON[ LKENSE� <br /> HC �I <br /> Q H �ITV ZIP PIIONE ULFNSE• <br /> PWM1IdWGCONiP�GTOR M1I��LADOtiC55 <br /> H � g <br /> �1]Y n _— <br /> �""� C�A550�\1'OPI( <br /> � H ❑ NE\Y ❑ A�DITION �( ALTERATION ❑ RE7_iq ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ �UILDING RELOCATION <br /> z CONIACT PERSON Pt1D VHONE NO I <br /> H y T[NANilA1PROVCMENLO�INi[RIOPR[I.�00[IONLY / <br /> rn $7, zpp �"� Perrv Johnson Director of Buildin4 <br /> �„� GONiPPCiCPICEO[lYORK �1 C <br /> (C� �C[/J pESCRiBEN'ORNANDSOl1AREi00tAGEINVOLVEO Services L58-1'S17 <br /> 3 �1t+ Tenant Im ro�ement —0— <br /> zHC1 PFOPOSEOOSEOfBUIL��NG IHEREBYCERTIFY?HAiIHAVEREADANDEXAM17INEDTH15APPLICA710NAND I <br /> I� Oy Dledical Office Bll11CZlil9 Courtvard CdfZ HNOIVTHESAMETOBETRUEANDCORRECT.ALLPROVI510NSOFLAWSAND <br /> ORDIN4NCE5 GOVERNING THIS NPE OF WORK\YILL BE COAIPLETEO WITH � <br /> LEG�L�ESCRIPLiGNUF�ROPERiYISNOWNBELOWORARACNiOIIPGOPIE51 yy�{ETHEFSP[GfIEDh1EREINOFNOT.TNEGRANTINGOFAPERMITDOESNOT I <br /> PFESUtdE TO GNE AUTHORIN TO VIOLATE CR CANCEL THE PROVISIONS OF <br /> i0r B�otK or ANVOTHERSTATEORLOCALLAWREGULATWGCONSTRUCiIOYORTHEPER� <br /> FOF7h1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV TNE OWNER OF <br /> THIS PROPENNTO PEPFOR1d THE WORK FOR�VHICH APPLICATION IS�fAUE <br /> AND I COt.7PLY \VITH THE STATE CONTRACTORS LAW 1827 RC\Y AND <br /> 296200 WAC. <br /> $QNAIU�EOfF�NfRACiO�O�'.111110RIZFDAGCNI OATE <br /> X /�/ _s/za/90 <br /> PROJECiADDFE55 AP�LiCXViSGOv U � 9Sli�ENS[NOAND�US�NESSNAti�E <br /> 1330 Rockefeller — . �_« ,, ,i I�',-f-� � <br /> PLUMBING <br /> � �' MECHAN�CAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. T'PE OF EOUIPMENT FEE <br /> /� �' NC-A/HNDLGUNIiS-H.P. _ <br /> YJATER CLOSET�TOI LEn <br /> � �� _ _ _ FOFCED AIR SYSTEAIS-&T.U. M EA _ <br /> �_. BATHTUO I <br /> LPVATORY�W4SHBASIN) _ UNITHEATEFS-BT.U. A1 <br /> 1 ' SHOWER — CLO7HESDRVEqS _ I <br /> �_ KITLHEN SINK8015P. VENTILATION FAN I <br /> ! 1 DISHWASHER __ AANG[MOOD — <br /> '� WATER HEATER I <br /> �' LAUNDRY7RAY _ — <br /> CLOTHESWASHER WOODSTOVE — � <br /> � � URINAL _ ____ ti�ETA��IREPLP.f.EBCHIMNEY _ 'I <br /> I I I DRINKING FOUNTAIN _____ FIFEPLACE INSERT _ _ i <br /> � FLOOR DRAIN HEAT PUA1P <br /> BACKFLOW PREVENTERS GAS PIPING — <br /> ROOF�RAINS-RAINLEADEf7S __ ERHAUST FAN __ — i <br /> '_• —_ <br /> _'w SIN K�SERVICE-BAR.ETCJ ----- I <br /> i'�, Il <br /> SUBTOTAL 5 SUBTOTAL 5 � <br /> � P[PA7IT 5 ——- PERh1lT `+' _ _ '. <br /> � 10TAL FEL 5 T0T,1L FEE :�J <br /> �a�l_. fRONI5E1tlPC� FLAlISL1UPCR SiOLSCiOACn PIANCNECItNUMOEN FEE PECEIPTNO. <br /> �jc a �ia3L � �1 _3 � �13 � � L <br /> u5ciar+ �o�nnEa vsCAntSrte FEES VALUATION FEE <br /> �_Z �,Es ���a <br /> Ol11LDING J ,7�--p �1��-'_"�� � <br /> tYPEOFCOH51 OLGUPANCv4ROUP NOOFOW[LIINGUNi15 — � <br /> ALLON�OL[/ALTUAL Q n �� PLUTA�ING _ <br /> �� �� <br /> yr�nro�De �+ooFsonrts os•ei occtonD h7ECMANICAL <br /> �� S� / . — - -- — <br /> iN - <br /> n[mirtu uuuor� OTHER <br /> rire srnivK�ensn[omaeo vE5 ❑No STATE BUiLDING SURCMARGE <br /> STATE EIIERGY SURC114RGE I <br /> acrcC+uov>CCer rUNSncvRBv� I P11�3LICV.0�7K5--_-- ---- — ,• <br /> /..�i�� I rora. 5c /�.-�'— _ <br />