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rERMIT APPLICATIO� <br /> BUILDING/MECH�NIGAL/PLUMBING/SI�N/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT �ERMIT SERVICES <br /> 3200 Cedar St., Everett, VJA 98201 -425-25i-881C- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE A::CEPTED FROM 8 AM TO 4 PM /— �o�Z <br /> SITEADDRESS: I�I�'-' AV� SE PROPERNTA%p PERMIT# <br /> 12800 Bei#etl�verett.ki+►qr,98208 Z U I 'C1t�S <br /> LEGAL lor new wnslruction: Short PlaUsubdicsion Lot Na_ (attach copy of long Icqal description) <br /> OWNER Providence Health and Services . Pnonc�E-maii <br /> nddress 1801 Lind Ave SW Ciry�state�ZiP Renton,WA 98057 <br /> CONTRACTOR Mortenson Construction L&I Lic. t! D � O - <br /> address 14719 NE 29th Place,Bellevue,WA 98007 PnonelEmail 425-895-9000 <br /> TENANT E JSINESS NAME CONTACT FOR PERMIT <br /> Providence Health&Services,Mili Creek Clinic Dan Huberty,ZGF Architects <br /> PhonelE-mail 206-623-9414/dan.huberty@zgf.com <br /> BUILDING PERMIT APPLICATIO�� CONTRACT PRICE OF WORK 5150,000 <br /> Existing Use ol Building Medi[al Office Building ��HEAT SOURCE: <br /> Proposed Use of Building Medical Office Building Gas x E�ecmc othcr <br /> 8uilding lype: _Single Famiiy _Duplex_fownhouse _Mul�i-Family X Commercial <br /> Type of projecC _New _Addition X Remodel _Repair_T.L_Sign_Spnnkler_Demolition_Change of Use <br /> D05criD�ipn of Work(additiona!space provided anlhe back): <br /> Remodei of unoccupied second level surgery area to temporary medical records administration area;approx 2600 SF. <br /> Have you started working without a pertnit7 _YES x NO � <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Project: _New_qd� � x Alleration_Rapair Type o(ProjecC _New�-__-Addn x Altorallon Repair <br /> Show Number(R il�itures Show Num6cr pJ o/lixfures <br /> � AIC-a r handGng unils modi in Toilet NA <br /> Forced air systems NA � � ' Baihtub NA <br /> Gas pi in N� L�avato (wash 6asin N/1 <br /> Wa�er hea(er NA Shower NA <br /> Gas fire lacr. NA 1 Kilchen sink 8 dis osal <br /> Gas range NA 7 Oishwasher <br /> Clothes dryer NA Clothes washer NA <br /> Ran e hood Water healer NA <br /> Exhaus�fan NA Sink service/6arlmop/etc. NA <br /> Hcat �ump Backllow reventer NA <br /> Unil healer NA Urinal NA <br /> Boiler NA Drinkin Founlain NA <br /> Refri eration NA Floor drain NA <br /> Woodstove Grease irap <br /> Ductin (modi in existin ) Rooldrains NA <br /> Other Medical Gas NA <br /> SPRINKLER I SUPPRESSION SYSTEM Other: <br /> Number of Heads modifiCationi to Other: <br /> exisUng per space ayout <br /> I hereby certity Ihal I have rr,ad anA esaminetl tAi;appliwlion and know the same lo br.Inie and[orrecl All provisions of laws anA ordinances goveminq <br /> Ihis lype ol wo �II b mplie wilh whelher specdieA herein or not.The 9ranling ol a permil does not presume to give.uthonly lo viola�e or uincM <br /> Ihe provisior of a t � stal Ior.� I law regulo6ng conslmr.lion or Ihr.peAormance ol con,Imclion. ihat 1 am aulhorieed by Ihe ovmer ol this property <br /> /�Derio e wo o I' irh p liwt on is maGe anC I comply with Ihe Sla�c Contraclors Law 102i RCW antl 296200 WAC <br /> ( <br /> �" _ � Zd1Z� <br /> OwnerlAulhorizatl Agent Si pa'u flale (HeviseJ71707 fJ <br /> 9/ <br /> � <br /> ! -- <br />