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i <br /> � cRMIT APPLICATI )N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425=?_57-t3810 — FAX 425-257-8857 <br /> SITE AD�RESS PARCEL TAX I.D.8 P�RMI7 a <br /> 1330 Rockefeller Ave. 00438524701100 6 0438524701101 g oa« -Gz <br /> LEGA LOT NO. BLOCK TRACT <br /> nesc. 11 to 22 247 <br /> OWNER ADDFESS ZIP PHONE <br /> Providence General Medical Center P.O. Box 1067 98206 425-339-3638 <br /> Finance Department Everett, WA I <br /> TENANT NAME CONTACT NAME PHOt�E I <br /> The Everett Clinic Mark Mantei 425-339-5460 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICEIISE N <br /> Kirtley Cole Associates, Inc. 1002 10 St. NE 98291 KIRTLCA2)2RF <br /> PHONE Snohomish, WA <br /> 360-568-3175 <br /> PROPOSED USE OF BUILDING Building f'l Mechanical Addition MEAT C•OURCE <br /> IPERh71T R Combination �_� Plumhing WORK � Alleralion [� E�ectric <br /> Medical Office 7YPE Demolition LJ Sign TYPE New Ga_ <br /> i B Sprinkler Repair/Maint. B O�her <br /> I CONTRACT PRICE OF WORK $480�000.00 CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION <br /> Remodel to an existir.g office building for use as a medical office. No exterior work. <br /> � Interior renovations include light gage metal stud wall par[itions, millwork, finishes, <br /> acoustical ceiling panels, and new electrical, mechanical, and plumbing systems. <br /> PLUM8ING MECHANICAL <br /> � N0. TYPE OF FIXTUFE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOV:ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> �_AUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAI FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAh1E TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF LAbVS AND ORIDINACES GOVERNING 7HIS TYPE OF WORK WILL BE COMPIIEU WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAI LAW FEGUWTING CONSTRUCTION CR THE PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFOAM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 29620 WAC. <br /> 2 <br /> Signatur wneuContr ctoriAuthorized Agent Date O <br /> �R�t� r�tg'u�-v►2�c. vt�(�.��. rN�. h <br />