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1 <br /> PtRM{T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 <br /> !�-� (,_/( <br /> SITE ADDRESS PARCEL TAX I.D.� 2$053000407200 I PERMIT# B����-OO7 <br /> 12800 Bothell Everett Hwy �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. See Atlached <br /> OWNER ADDRESS ZIP PHONE <br /> Providence Health Care Po Box 3s9672 Seattle, WA 98138 <br /> TENANT NAME CONTACT FOR PERMIi PHONE <br /> Childrens Hospital I Greg Moffett 253-826-0099 <br /> CONTRACTOR Fire Sprinklers Incorporeled ADDRESS �524 45th St E#102 Sumner,WA Z�P CONTR.LICEkSE# <br /> 98390 FIRESI'988RJ <br /> pHONE 253•&26-0099 — <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SGJRCE <br /> PERMI7 R�--( Combinalion R�.-( Plumbing WORK Alteration n Eleclric <br /> TYPE �j Demolition u Sign TYPE New � Gas <br /> Medical Office u Sprinkler Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETi�LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION 19 h2�d flfB SPfIflklef TI <br /> PLUM3ING MECHANICAL <br /> N0. TYPE OF FIXTIi:tE OR ITEM NO. TYPF OF FIXTURE OR ITEM <br /> WATERCLOSET _ AIC–AIHANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PR[VENTER _ GAS PIPING <br /> SINK(SERVICEIBARiMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTNER <br /> _ —I _ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAfuIE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING?HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM�TO GIVE AUTFIORITY TO VIOLATE OR CANCEL THE PROVISIQN OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUl HORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFtM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296100 WAC. <br /> �—� �Z 'S–�� <br /> Signature oi OwnedContraclorlAuthorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />