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PERMIT APPLICATION <br /> BUILDINGIMECHANICAL/PLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: PROPERTY TAX 11100411300602200, 00411300600101,1 ERMIT# <br /> 3901 Hoyt Ave. 1 00431100600100 1?21 c <br /> LEGAL for new construction* Short Plat/subdivision_________­...................... Lot No <br /> ------ ____ (attach copy of long legal description) <br /> OWNER The Everett Clinic Phone,'E-mail 425-259-1162 <br /> Address 3901 Not Ave. cityistatetzip Everett, NA 98201 <br /> APPLICANT: .......Owner --Owner's Agent --Contractor --Contractor's Agent __Tenant(must provide a lector of consent from the ow or to do work in the 9oscej <br /> CONTRACTOR The Everett Clinic IL&ILia# Building Owner-N/A COEBi <br /> Address 3001 Poyt Ave. Everett, NA q8201 lPhone/Emaii 425-25q-1162 <br /> TENANT BUSINESS NAME :ZY\j Floor CONTACT FOR PERMIT <br /> The verett Clinic Janet Mondo <br /> -rfAtR-rV\(J AAMI[cir, le lowef lcvd Phone/E-mail 425-823-2244 jonet@owerks.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building r dj—CQJLQMI —e--B—Ul ljdLing_------------ HEAT SOURCE: <br /> Proposed Use of Building_neL4i cci I Off ice -B u i Gas_._.._..... Electric__........ Other ... <br /> Building type: ---Single Family Duplex---Townhouse ---Multi-Family -X-Commercial <br /> Type of project: _,-_New ­Addition -X-Remodel ---Repair--T.I.­.-Sign....._...._Sprinkler -Demolition---Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> THE PROJECT CONSISTS OF MINOR ALTERATIONS TO AN EXISTING MEDICAL CLINIC. NO EXTERIOR WORK. MODIFICATIONS OF INTERIORS To <br /> INCLUDE; REMOVAL OF NON-BEARING PARTITIONS 4 CASEWORK.NEW WORK TO INCLUDE; METAL STUD HALL INFILL, NEW DOOR, FLOORING, <br /> CEILING AND MODIFICATIONS TO ELECTRICAL, MECHANICAL, PLUMBING SYSTEMS, AND FIRE-LIFE SAFETY SYSTEMS. <br /> ELECTRICAL, MECHANICAL, PLUMBING AND FIRE-LIFE SAFETY SYSTEMS TO BE BIDDER DESIGNED. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: ...........New ,Adcln Alteration Type of Project: .......-New .Addn ­-,­Alteration.-_-_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units 1 Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas ran ge <br /> Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(servicelbarlmopletc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting <br /> Roof drains <br /> Other Medical Gas <br /> SPRINKLER/SUPPRESSION SYSTEM Other: <br /> i Number of Heads i Other: <br /> I hereby cedify that I have read and examined this application and know the same to be true and correct A:,Wroy,s!ons of laws and ordinances governing this iype,of work wilt be cornoled <br /> with%-;',iotherspecified herein ofn The q riling of a permit does not presume to give authority to violate of canGal the provision of any other state or local law regulating construction <br /> That I .2hon this proatxry to pori the work for which application is made and I cor,D <br /> :lf with the State Contractors Low 18.27 RCW and 296 200A 1,1VAC. <br /> Date sed 612012) <br />