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PERMIT APP�ICATION <br /> BU ILDINGIMECHANICALIPLUMBING/SIGNISPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVI�ES /� —�'—I� <br /> 3200 Cedar St., Everett,WA 98201 -425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS: P0.lPENTYTAXM p8053000407200 P �ITY �+ � <br /> 1280U 19TH AVE SE EVERETT,WA 98208 ` L�. <br /> tEGALfornewwnslruaion: ShodPlaUsubdivision ProvidenceMedCntr LotNo. 1 (aaacicovyollonBkgaltlesrnv6onl <br /> OWNER Seattle Children's Hoso.-Mill Creek Uraent Care vrwoe�e�mau (206)786-9113 Shawn.Havely@macmiller.com <br /> Aoamss 12800 19TH AVE SE ciry/state/Ziv EVERETT,WA 98208 <br /> CON7RAC70R MACDONALD MILLER L&I Lic.tl MACDOFS980RU 12-31-12 <br /> .(206)768-�+278 dada.doll@macmilleccom <br /> ndaress 7717 DETROIT AVE SW SEATTLE,WA 98106 PhonelEma�l <br /> TENANT BUSINE55 NAME CONTACT FOR PERMIT DARLA DOLL <br /> MILL CREEK URGENT CARE pnonaE-ma�i (�O6)768-4278 dada.doll@macmillecwm <br /> BUILDING PERMIT !1PPLICATION CONTRACT PRICE OF WORK S 18.000.00 <br /> Existing Use at Building COMMERICAL/OFFICE HEA7 SOURCE: <br /> Proposed Use ot Building NO CHANGE Gas..__ Eiect�X Otner <br /> BuilAing rype�. _Single Family _Duplez_Townhouse _Multi•Family X Commercial <br /> Type of projecl _New _Addition _Remodel _Repair X T.I._Sign_Sprinklar_Demolition_Change of Use <br /> Descriplion ol Work(a4Cmonal s0aco Wo��rdo0 on tne back): <br /> INSTALL(2)VAV BOXES, INSTALL APPROX.(16)DIFFUS[R/GRILLES AND MISC DUCTWORK <br /> Have you sW rted working without a permit7 _YES X NO <br /> i!!ECHRNICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ot Project: _New Ad�n ,�Plterallon_Rapalr Type of ProJect: _Hew_Adtln _,Altoratlon_Repair <br /> Show Number(M)ol flrfuras Show Number(YJ of flxiures <br /> AIC—air handlin units I Toilet <br /> II Forcetl air s stems � 6athWb <br /> Gas pioin I Lavalory(wash basin) <br /> I Waterhealer I Shower <br /> � Kdchen sink 8 disposal <br /> � Gas Grep�ace � Dishwasher <br /> Gas mn e <br /> Clothesd er I Cloiheswasher <br /> Ran e hood i Water healer <br /> Exhaust fan � Sink;service/bar/mo0�etc.) <br /> Heat pump i Backllow reventer <br /> UNt hCatef � Ufinal <br /> �oiler I Drirkin Founlain <br /> Refri e�aGon I Floor tlrain <br /> � Woodstove Greasetrap <br /> X �� Ductin �I Rooldrams <br /> ' Other VAV BOXES j Mediwl Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM I i �1hef C I II�1 C S(rl �- <br /> �� Numbe�ot Heads i Other. <br /> �p�i�py�crpfy ihal I�ave reaa and e.am�neC Ifus appliwtion and hnav t�e came to�e tme and corteq AII pmvis�ons ol laws an0 orCinances goveming <br /> ims rype c�v.ork h+il Ce compheC wim vmetner speclficW rereln or not TTe gmnting of n pertnil Coos no1 presume to 91ve authonry�to�iWate w canml <br /> Ina provision ol any otner slale or Ixal law re9ulating constn.•cbo�or t�e peAo�manCC ol constNCfiO��Tnat I em auttlonZed hy IOe O�er ol thi9 propetly <br /> to pCr9_rm tne work�or vfiirh app�iuwon is matle antl I comCy xiln the Slole Con�2Rors Law 18.27 RCW and 298 200 WAC <br /> '\ <br /> . �� _ _ � . .j,(,'.�, . 12-02•2011 <br /> '� � . .� Oa:c (Rovactl7f107f) <br /> OwnerlAUNotlzeC ABenl5lgnaturo <br />