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'��F°��' �'�JNSTRUCTION <br /> GITY OF n <br /> APPLICATIVN FOR CONSTRUC7r�N PERMIT everett PERMIT PERMITNO. _ 24JO � <br /> 259 - 8810 <br /> everett <br /> ihcEve�g�een � ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br /> GTV OF <br /> everett ��ER MNLFO�RE55 CIiY ZIP PHON <br /> �verett General Hospital P.O.Box 1197 Everett, WA 98206 258-6300 <br /> BUILDIN, DEPARTMENT iENA r MA oaess �� 98201 z�P PMONE <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT `�ort Gardner 1330 ttockefeller �Cd°e. 3rd Fl. Everett, <br /> I I DEMOUTIO� IJ COMBINATION i BUILDING I IMECHANICAL �PLUM9ING U SIGN ARCNITECTORD[SIGNEP AfAILADDRESS c�,. z�P PNONE <br /> OWNER MML�ODRESS CI7Y 21P PNONE <br /> �L��� �` _^ w � ���� �`'��', I/ 04 • � GENERRLCONTRACTOR 1.141LADORE55 dTY 21P PHONE LIGENSE• <br /> � •J'vcr� S r >GL 1 '.l U G. � - �i ' V 3 d O <br /> /IE'N��NT ^ hlntL�DzDNE55 �1 C�TV 2�P PHONE <br /> "i Q!�'+ l�l��D{`�Z� I J✓� I��C ('�'�Z_I�'L-� J�D f"� C ���t%�4�7 ____ MECNANIGALCCNTRACTOR AIAILADDRESS QTY LIP PNONE LICENSE• <br /> MGIIIIECT Cfl DFSIGNEB M�IL AOOfIGSS CITY 21P PIIONE <br /> L�.ty:anlc�W ��`�� ��� /FM1C�—��� �L � / � �'- •3a'y - =L PLUMBINGCONTRACTOR MAIL�DORESS CITY 21P PHONE LICENSE� <br /> GEN[R�LCONTRr�GT011 M�ILADDRFSS cin zm ruor+e UCENSE� RXH Co. 81:. Woodland Way Kent 98031 859-5417 <br /> CUSS OF WORK <br /> MECNANICALCONTR�CIOR MML�ODFlC55 cirv zir ruorie LIGENSE� O NEW O ADDITION ❑ ALTERAfION ❑ REPAIR ❑ DEMOLITtON ❑ BUILDING RELOCATION <br /> , � ` /� �C 1 CONTACT PEIi50N AND PMONE NO IF OTHER TMAN ABOVE <br /> A ?il�, l.J�r.U�t�_<4'_MN �'t.,�4. `if�o31 8593-Y17 P.X/fCc����.:.l�JRt <br /> _ PL M01 G CON7R4CTOR MAIL ADOf1GS5 �CITY ZIP PIIONE LICGNSE R CONTRACT PRICE OF WORK:S <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOWED <br /> C14550F WOIi`K� Plumbing <br /> � ' NEW �ADDITION I.I ALTERATION I I REPAIR I 1 DEMOLITION I I WOODSTOVEIFRPL INSERT I J BUILDING HELOCATION <br /> iEN�NTIMPAOVF.MENTOAINTEPIORREMODELONLV CONiAC ERSONANDPIIONENO `, <br /> CONTR�CT PRICE OF WOPK: � k k• r"�I �jL�L/¢�f=_ _�� ST I/ PROPOSED USE OF BUILOING <br /> DESCNBEWORNANDSOl1�REFOOTAGEINVOLVED Medical Bldg. <br /> /)fS�.Q.!`/O � �I/�/ L LEGAL�ESCRIPTIONOFPROFERTY�SMOWBEIOWOR/TTALNFOURCOPiES) <br /> rnoroseouseorewioiwc � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> LOT�— BLOCK—OF <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG�LDESCRIPiIONOFPROPERTY�SHOWNUELOWOR�TTACHfOURGOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITY. WHETHER SPECIFIED HEREIN OR <br /> �oi BLOCK oF NOT. THE GF7ANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE J08 ADORE55 <br /> PERFORMPNCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE 1330 Rockefeller � � � <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH MECHANICAL � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE PLUMBING <br /> CONTRACTORS LAW 1tl.27 RCW AND 296.200 WAC. Np, TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF Ea FEE <br /> SIGNAIUR OFCONiRnC7000nnU7110RIZE0aGENT DAiE <br /> 2 WATER CLOSET(TOILET) IO OO �+/C—A/HNDLG UNI — ,� <br /> /_ ^`�`� BATHTUB FORCED AIF SYSTEMS—B. �d EA. $O. O <br /> // / / UNIT HEATERS—B T.U. ^ i <br /> �S. , rT7h.l 1_ Z LAVATORV(WASH BASIN) LO OO <br /> PROJECTADORE55 — — 6���CJ~� <br /> 3� APPLICnNt '11YnUSNF.5,110EN5ENOnN00UuMhSSNnME SHOWER CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN SH $1 1.�O <br /> PLUM ING MECHANICAL DiSHwnSHEA RANGEHOOD <br /> NU. TYPE OFFI%TURE ORITEM FEE NO. TYPE OFEOUIPMENT FEE LAUNORYTRAV 1 WATERHEAT[F 6 5 <br /> sZ WATER CLOSET(TOILET) __� �71� NC-NHNDLG UNITS-N.P. � CLOTHES WASHER wOOD S70vE <br /> BATHTUB i FORCED AIR SYSTEMS-B.T.U. M E.A. ' UPINAL METAI FIREPLACE 8 CHIMNEY <br /> LAVATORY(WASH BASIN) UNIT FIEATERS-B.T.U. M �_ DRINKING FOUNTAIN FIREPLACE INSERT <br /> SHOWER � CLOTHES DRYERS � FLOOR OPAIN HEAT PUMP <br /> KITCHEN SINK&DISP ; VENTIL�TION FAN i BACKFLOW PREVENTERS GAS PIPING <br /> i EXHAUSTFAN <br /> DISHWASHEF � RANGEHOOD �_ ROOFDRAINS-AA�NLEADERS <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER __ <br /> � WOOD STOVE � lO SINK�SERVICE-BAR,ETCJ SO OO <br /> URINAL ' METAL FIREPLACE 8 CIiIMNEY � <br /> DRINKING FOUNTAIN � fIREPLACE INSERT _�_ sUB 70TA1 S Sue iOTn� S <br /> FLOOR DRAIN I�IEAT PUMP ! pEpM1T S PEflMIT 5 <br /> BACKFLOWPREVENTERS _ GASPIPING � TOiA�FEE f TOTALFEE S <br /> ROOF DRAINS-RAINLEADERS EXH�UST fAN � <br /> FnONTSETenCK PEARSETBNCN SioESEroACR PLANCHECKNUMBER FEE RECEIPTNO. <br /> D S�NK(SERVICE-BAR,ETC.� _���_ � <br /> i � VACANT SITE <br /> usEznNE ioT^REn FEES euiioiNccooe FEE <br /> � ' ❑ VES ❑ NO <br /> ' or�nr.vc. o BUILDING S <br /> � � IYROFCONSiPUGiIONALIOWABIE iV1"40fGONSiNOC�iONACiOAt � ��0'� OWEtlI4GUN115 <br /> ' � PLUMBING 80 00 <br /> SUB TOTAL $ ; SUB TOTAL $ � size o�eioc NO OF Si0R�E5 ense�+Far <br /> � PERMIT $ � PERMIT $ � ❑vES � No MECHANICAI. <br /> TOTALFEE $ � TOTALFEE S � p�CUPANCYLOA� FIRESPRINNLERSREO'D MPIGHT�IMITATION OTHER <br /> FRONTSETOAGN i7EARGET04CK SI�ESEIOACR �'UNCIIECKtlUM�EIi �EE �ECEIPINO. ❑yES ONO i <br /> STATE BUIIDING SURCHARGE <br /> RUSON FOR SPRiNNLEliS <br /> useza+[ iornnen vncnNrsn� FEES VALUATION FEE <br /> STA7EENERGYSURCHARGE <br /> I I VES I I NO pUILDING ; <br /> [Kcu�uKv iioMlmTlliXG11Ni15 ___ APPLICATIONACC.BV PLANSAPPflOV[D0� CITY OF EVERETT <br /> tvr[orcmisrnuawnoic nrecrcaxsiac�uni cnar ' LOCALSALES PUBUC\YOflKS <br /> PLUMOING � TAX CODE IS TOTAL 86 50 <br /> srzeoroioc; r+o.ors7oni�s nnscMrni MECII�NICAL � 3105 <br /> WHEN PROPERLY VALIDATED THIS IS VOUR PERMIT <br /> I I YES I I NO � <br /> OCCUMNCYLO�O FIRESPRNKLERSREO'U ��EIGH1111dIlAiION �T��ER � <br /> ❑ YES I I NO STATE BUILDING SURCHAfiGE � <br /> --r— <br /> nensoN ron srnn+rc�ens -- � <br /> S1ATE FNEf1GY SUI7CHAl1GE � <br /> nrrucnnotrncc.ov PinNsnrrnoveonv CITYOFEUERETT runucwonKs ' <br /> LOCALSALES <br /> � <br /> TAX COOE 13 3105 TOTAL � anor3[ss Fi�t 2 4 9 0 � <br /> PEflMITS EXPIRE IF WORK IS NOT COMMENCED WITHIN <br /> �- 180 DAYS OR CEASES FOR MORE THAN 180 DAYS. <br />