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APPLICATIO" FOR CONSTRUCT� ,N PERMIT � <br /> . TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEA7ING SYS7EM: �J GAS ❑ELECTRIC U <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br /> °M'"ER Providence"�eneral Medical Cen�er Everetz� , WA 98��E 261-2646 <br /> TENANT M�ILADURE55 CIIY TIP pNONE <br /> Everett Cardiology Associates 1330 Rockefeller Avenue Everett ��A 98201 <br /> �RCNITECTOROESIGNER M�IL�DDRESS CITY ZIP �I!ONE <br /> Connell Design Group 22000 64th Avenue i9/ Suite 2F Diountlake Terrace, WA 98043 <br /> �ENERALCONTA�CTOR M4RADDIIFSS CIIV =IP PIIONE STATEUCENSE� <br /> Rirkley Cole Associ:�tes 1002 lOth PO Box 1179 Snohomish �4A <br /> MECIIRNICQCONiRACIOR M�ILAUDRESS CIiV ZIP PNONE • SiAIELICEN5E1 <br /> PWMBIN6CONTRACTOfl M4ILAODFlE55 CIIY 21P PIIONf: STr1TEUCENSEI <br /> CLASS OF WIX1K -- <br /> I I NEW I I ADDITION I �ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> CONf�CT PERSON 6NU fNONE ND. <br /> CONTRACTPRICEOFWORK 90,000 Barbara Lindsey, Manager, Property <br /> DESCRIBE WpiK AND SOU�RE FOOT�GE INVOLVEO <br /> Tenant improvements 44(nla� / Managment 261-2646 <br /> rnoroseouseoFevnowa � I 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Medical office bUllCllflg APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> LEG�LDESCRIPTIONOF PRpCERTY(SHOWN BELOW OR�TTACHFWRCOPIES) PROVISIONS OF LAWc:ND URDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETEU WITH WHE7HER SPECIFIED HEPEIN OR <br /> �ar BLOCN oc � NOL THE GRANTING OF A PERMIT DOES N01 PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATF OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION,T11AT I AM AUTHORIZED BY THE <br /> OWNER OF THIS ?ROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION 18 MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � _� <br /> PROJECT '7DRESS x.'+�nmE " �ry/`� �i A� /U '� � y� <br /> n+�r <br /> 1330 Rockefeller Avenue �„yB,�„��„��„�,� <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—A/HNDLG UNITS—H.P, , <br /> BATHTUB ' FURCED AIR SYSTEMS—B.LU. M [.A. �— <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYEFS � <br /> KITCHEN SINK d DISP ; VENTILATION FAN ; <br /> DISHWASNcR � RANGE HOOD —�— <br /> LAUNDRYTRAY ; WATER HEATER ~ <br /> CLC�THES WASHER � WOOD STOVE ; <br /> URINAL � METAL F�REPtACE 8 CHIMNEY � <br /> DRINKING FOUNTAiN � FIREPLACE INSEHT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PtPING � <br /> ROOF DRAINS—RAINLEAOERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � ; <br /> � � <br /> � ; <br /> i � <br /> i , <br /> SUB TOTAL S i SUB TOTAL S ' <br /> PERMIT $ i PERMIT S i <br /> TOTALFEE E ; TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBhCK REM SETBACK SIpE SF.lOACK PLAN CNECK NU�R f�EE_ ,/9 RECEI�NO. � / <br /> c J <br /> 5 .,� ' G � <br /> usezor+e tornnen � vncnursne FEES VALUATION FEE <br /> BUILDING ( �l� —� i �/} <br /> tYVEOttONtSAILOWABLE IYf'[OftON51.�C1UAt nxurexcr xoaw.¢wxruxns —�vL <br /> /I F" . 'F�/Z cqmn� � PlUM81NG � <br /> �-Z — - <br /> � <br /> SREOf OLDG. NO OF STORIES BASEMFNT MECHANICAL i <br /> v� � ' <br /> , 6/ r • �. , <br /> occurnNcviono rmesrnnKiensnEoo HFIC,IIiLIM1i11T10'J ADDITIONALPLANCIIECH � <br /> �_ Y�5 SPfiINKLEfi i <br /> nensor�ron srniNK�rns — ' <br /> ,�+�5��7, STATE BUILDING SURCHMGE i �� <br /> INiAREB� ri.nr+s rrnovFnov CITYOFEVERETT pueucwo�Ks �� <br /> hrj LOCAL SALES <br /> _ �� TAX COOE I3 3105 rora� � `� �' ��, <br /> � , <br />