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r r <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> < 425-257-8810—FAX 425-257-8857 <br /> '�J�II�� �,Y1�Cf; <br /> SITE ADDRE3S 1 PARCEL TAX I.D.S PEFjMIT p <br /> 1330 Fockefeller Ave:"Suite 300 00438524701100 6 00438524701101 �3�0- <br /> LEGAL LOT NO. - -�-�"9LOCK TRACT <br /> DESC. I1 to 22 247 <br /> OWNER ADDRESS 21P PHONE <br /> Providence General Medical Center P.O. IIox 1067 98'?06 425-339-3638 <br /> Finance Department Everett, WA <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> The Everett Clinic Mark Mantei 425-339-5460 <br /> CONTRACTOR ADDRESS LP CONTR.LICENSEN <br /> Kirtley Cole Associates, INc. 1002 10 St. NE 98291 KIRTLCA272RF <br /> PHONE <br /> 360-568-3175 <br /> PROPOSED USE OF BUILDING f3 Building Mechanical n Addition HEAT SOURCE <br /> PERMIT K Combination R�.�( Plumbing WORK ��{( Alteration � Electric <br /> � TYPE �( Demolition u Sign TYPE �j New Gas <br /> ��(�,,y�,�L Ll Sprinkler U RepaidMaint. Other <br /> CONTRACT PRICE OF WORK $110�000 CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORI:DESCRIPTION Remodel to an exieting office building for use as a Medical Office. <br /> No exterioi' work. Interior renovations include light gauge netal stud wall partitions, <br /> millwork. f:nishes, acouetical ceiling panels, and new electrical, mechnnical, and plumbing <br /> systems. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) — UN TTHEATERS <br /> SHOWER — <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL�IREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACF <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER _ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED nEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIOPJ. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RGW AND 296.200 WAC. <br /> �"`G�•- � �L <br /> Sign �of Owqer/GonlractorlAutho 'ze�e_nt^_� �� ate <br /> �'��` D IT 8 C EU T ARDS ARE NOT ACCEPTED <br />