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-� PERMIT APPLICATIO^� <br /> BUILDINI 1ECHANICAL / PLUMBING / SIGN �RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> -- 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:3901 Hoyt Ave., Everett,WA 98201 PROPERTY TAX#:0041 1 3003001 01 <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �� CONTACT INFORMATION � <br /> OWNER NAME: EVeI"ett CIInIC TENANT NAME(If Commercial): <br /> n1AlNER MAILING ADDRESS: sTREET 3901 Hoyt Avenue <br /> CITY Everett STATE VV� ZIP 98201 �- <br /> OWNER PHONE:425-328-6825 OWNER EMAIL:mgriffith@everettclinic.com <br /> ChrtiTRACTOR NAnnE:Viking Automatic Sprinkler Co. <br /> CONTRACTOR ADDRESS: srREEr 3434 15t Avenue S. <br /> �Y CITY Seattle STATE VV�"'� ZIP 98134 <br /> G;ONTRACTOR PHONE:206-622-4656 CONTRACTOR EMAIL:dwight.bickler@vikingsprinkler.net <br /> CONTRACTOR LICENSE#(REQUIRED):VIKINAS373NT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024704 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-622-4656 <br /> �". Dwight Bickler CONTACT EMAIL:dwight.bickler@vikingsprinkler.net - <br /> � BUILDING PERMIT APPLICATION <br /> Fxisting Use of Building:Opthalmology Contract Price of Work: $5soo.00 <br /> Proposed Use of Building:Medical Heat Source: ❑Gas �lectric ❑Other <br /> Buifding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> GF:•.�.�CRIPTION OF WORK: <br /> _ Relocate and add fire sprinkler heads for new floor plan design. <br /> A��OCIATED BUILDING PERMIT#(if applicable): i) (`� �J�r -C%`.� -� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typa of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair • <br /> #of Lisf of Fixtures #of List of Fixtures #of List of Fixfures #of List of Fixtures � <br /> Fixtures Fixtures Fixtures Fixfures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)-- <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> x Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain " - <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap <br /> � Gas Range Ducting Dishwasher Roof Drains - � <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> ..,... <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> WET SVSTEM(T.I.) Number of Heads s <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is t�ue and correct. Work done pursuant to this pe�mit must comply with <br /> cU[rent federal,state, and/ocal law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the . <br /> Gii�i�ling Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made,, <br /> and 1 compl}�with the State Cont�actors Law 18.27 RCW and 296.200A WAC. <br /> �, <br /> ti City of Everett Official Use Only <br /> �, � .�— PER IT#_� � � <br /> !��Ct,��-`" ��� �'���j � � �-���/� <br /> O�mer/Authorized A t S gnature Date (Revised 10/12/2015) <br /> _ -i <br />