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APPLICATIt.N FeR CONSTRUC'. .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-BB10 <br /> ❑ DEMOLITION rl COMBINATION � BUILDING fl MECHANICAL (l PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> OWNER MAILADDRESS Cltt ZiP PMONE <br /> Providence General Medical Center PO Qox 1147 Everett, WA 98201 261-2646 <br /> TENANT MPIlA0DRG55 CITY ZIP PHONE <br /> Everett Clinic OB 1330 Rockefeller Avenue Everett, WA 98201 <br /> ARCIIITECTOROESIGNER MAILADDFESS Cltt ZIP PIIONE <br /> Martenson Clark 9750 NE 120th Place Suite #6 Kirkland WA 823-2244 � <br /> GENEfiALCONTRACTOR MAILAUDRESS CIiY 21P P110NE STATE�ICENSEr <br /> R.C. Enterprises 2315 189th PL PlE Arlington WA 98223 652-7070 <br /> MECHANICALCONTPACTOR MAILADDRESS CITY 21f' PIIONE STATEUCENSE� <br /> PLUMBINC�CONiRACTOR MAILA��RE55 CITY ZIP PHONE STATE IICENSE� <br /> CONT T PRICE OF WORK . <br /> �3 � � HEATING SYSTEM: I � GAS ❑ ELECTRIC ❑ <br /> � ' <br /> DESCRIBE WO K ANU SOUARE FOOIDGE INVOIVED CONTnCT PEqSON ANO PIIONE NO <br /> T/Improvements 1857 sq. ft. Barbara Lindsey, Manager, Property Manager <br /> 261-2646 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BF.TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BUILDING PROVi510NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> M dical Office 6uildin WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGRLDESCRIPTIONOFPROPER7Y�5HOWNBELOWOflATTACMTWOCJPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCT�ON.THAT I AM AU7HORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> PARCELTA%I.D.NUMBER <br /> CONSTRUCTONLO�NLENDER.PDURESS.TELEPNONENVMBER x���"^��' �J,+z� // /�—�� <br /> SIGN�TURE DATE <br /> 1330 Rockefeller aneusinessucer+s�r+o. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI)RURE OR ITEM FEE NO. TVPE OF FUCTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � AIC—AlFiNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEATPUMP ' <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) ' <br /> GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE ' <br /> � GAS PIPING � <br /> ; EXHAUSTFAN ' <br /> � � <br /> � <br /> � � <br /> � � <br /> 1� <br /> SUBTOTAI S � ; SUBTOTAL S � <br /> PERMIT 5 ,O � PERMIT S � <br /> TOTAL FEE S '�'L ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK RE�RSETBRCK SIOESETDACK P�ANCHECNNUMOF.R � FEE l � AECEIPTNQ.,�� <br /> z � '`� <br /> USE 20NE LOT PREA VACAGT SITE �/ ` <br /> FE S VALUATION FEE <br /> IlYES f� NO OUILOINC �j rG� / � � <br /> HEIGNTLIMITATION NOiTM�WELLING 512EOFO��R�.��r � — <br /> m% [�' �.� PLUMUING � <br /> i <br /> OCCUPANCY NOO�/S�i0RIE5 OCCUPP/NT�LOAD BASEMENT M[C11nNICAL � <br /> GRO' N4' C� f�(/ fl NO � <br /> i <br /> AODITIONFL PIAN CHECK � <br /> i <br /> FIRE ALARM REO'D REASON � <br /> i <br /> OTI/ER � <br /> i <br /> fIRE SPRINKLER REO' REASON j • <br /> STAiL OUIIGING SURCHARGE <br /> i <br /> i <br /> TYPEOFCONST. PLANSAPPROVEODY CITYOFEVERETT ���UC`NORKS ' <br /> �M LOCALSALES � �j�S , <br /> onTe I � � � TAX CODE IS 3105 TOTAL <br />