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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.or <br /> O?7WAMai-o6-y pi ct o ' (x' <br /> SITE ADDRESS: 3901 Hoyt Ave,Everett, WA 98201 PROPERTY TAX# PERMIT# <br /> -1-50.9=053 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER Everett Clinic Phone/E-mail 425-328-6825 <br /> Address 3901 Hoyt Ave City/State/Zip Everett, WA 98201 <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR University Mechanical Contractors, Inc. State Lic.# UNIVMC*343N9 City Bus. Lic.#006726 <br /> Address 11611 49th PI W, Mukilteo, WA 98275 Phone/Email (206)364-9910 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Chris Kenny <br /> The Everett Clinic <br /> Phone/E-mail (206)641-4457 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family Commercial <br /> Type of project: New Addition Remodel Repair T.I. Sign Sprinkler Demolition Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): Z ely ro 41 Af— <br /> (A, JfJ Pf1 - ele u f dlftc► ► �P(�fl is P� �-�- sJP�iy <br /> coAck t maw c--t- -A✓. Sq <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: New 1 Addn _Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping 2 Lavatory(wash basin) <br /> Water heater Shower <br /> • <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump _ Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM 1 Other: Supply to Humidifier with RPBA <br /> Number of Heads 1 Other: Indirect waste for RPBA <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp) <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am aruthotized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />