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10333 19TH AVE SE SHIFA HEALTH 2017-03-08
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10333 19TH AVE SE SHIFA HEALTH 2017-03-08
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Last modified
3/8/2017 11:40:52 AM
Creation date
3/8/2017 11:40:43 AM
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Address Document
Street Name
19TH AVE SE
Street Number
10333
Tenant Name
SHIFA HEALTH
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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.org <br /> SITE ADDRESS: PROPERTY TAX# MI <br /> /0343; /cti? A y£' S �V LL _ O /O306coo ro/Do _ P r I'T0(67 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER 1-e// Y <br /> V 1 _413- Phone/E-mail <br /> Address t O 333 tett-kt A Vc � G` City/State/Zip gr v e y 11. .e u9-01 <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 j/�jYj �y u4-Z/T E C 7;ec State Lic.# CC ( 000 City Bus. Lic. <br /> Address 4/9.27- /f3J/ ,4 S 4 1a7 MX Phone/Email l `'..4(A <br /> TENANT BUSINESS NAME[ 7-7 CONTACT FOR PERMIT <br /> 7 ,J'/y &iLL�LA-&1/1 <br /> // 6� //t— Cllr � Phone/E-mail V�J T��o�1� /vai/'(a/4 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 51000 <br /> Existing Use of Building "tig i hal Ir S4IOY HEAT SOURCE: <br /> Proposed Use of Building :r1L J7 /{ V Gas Electric Other <br /> Building type: Single Family Duplex Townhouse Multi-Family X Commercial <br /> Type of project: New Addition °Remodel Repair ' T.1V Sign_Sprinkler Demolition Vhange of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): A i gip t ,-nA� <br /> � V "V <br /> �.!' o-C-F i c e 'a s <br /> I eh 4'K+ I wt Ya v evu e -I- -Coy. l9 vt►-1-- 101 <br /> .4) ,fi - <br /> rvwc2 Kim <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan :f' 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 Other: <br /> Number of Heads Other: <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.T e 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 authorized by the• er of • property to perform the work for which appli ation is m e and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent ignatu e Date (Revised 9/2014) <br />
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