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. , <br /> � . � <br /> � ' ��' �=���� � ��� PERMIT APPLICATION <br /> BUILDINGIMECHANICALlPLUMBING/SIGNISPRINKLER/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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S O�`� <br /> SITEAD�RESS'- � —'jj.�—•�---- PROPERTVTA%p 00438524702102 PERMI a <br /> f7 u0 I3 5.7� 1 05-Ob <br /> LEGAL lor new consimclion ShoA PlaUsub�iviswn NA Lot No N� (allach ccpy ol long le9al descnplion� <br /> owNeRProvidence Regional Medical Center ,no„e,E-m;,,,N/A <br /> ��a,�„1800 13th Street cnyisi:,i�iz�p �verett, WA 98201 <br /> cONrw.CroR Hermanson Company �g i �;c p 37262 <br /> naaress 1221 2nd Ave N Kent, WA 98032 ano�e�ema�i2533101932, bfox@hermanson.com <br /> TENANT BUSINESS NAME CONTACT FOR PERM�T <br /> Providence �„o��,F.ma, Brooke Fox <br /> BUILDING PERMIT APPUCATION CONTRACT PRICE OF WORK St75,00000 _ <br /> Exisling Use of Bwiding ��edical Cemer HE/1T SOURCE � <br /> Proposed Use o(0uilding h1edical Cenler Gas___ [lectnc__ Other__ <br /> Buildinq rype _Single Family _Duplex_Townhouse _Mulli-Family �Commerciai <br /> Type of project _New �Addllian _Remodel _Repair_1'I _Sign_Sprinkler_Demolition_Change of Use <br /> DeSCnpliOn Of WUfk(addd�onalspacepmvidetlonlhe6ack�� If151�31� �4� f1CW VF�V I2ffT11l12�I Uf11lS Wlffl hYd(Of11C (8h02f, <br /> heating water piping, supply air duct and GRD's. <br /> Subconlrolacotrs include new controls for VAV's, <br /> Have you sWrted working without a permit7 _YES x_No mechanical insulation and tesVbalance <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJecf. ,New�.Addn __AIlention,Repair Type of Pro�ecC _New AAdn _Alteration_Repair <br /> Show Numbcr(bi ol lizWics Show Numbcr(a)al fixfures <br /> NC-av han0ling umts Toilet <br /> Forced air s stems �athtub <br /> Gas p�ping lavalory(wash 6asin) <br /> Wa�er heater ShOwef <br /> Gas 6re lace Kdchen smk 8 tl�s osal <br /> Gas ran e � Dishwasher <br /> Clolhes dryer � � �Clothes washer ' � <br /> Range hood � Waler heater � ' � <br /> [xhaust fan Sink servicelbar/ma letc <br /> Heal um Rackllow revenler ' <br /> Und heatCr Unnal '� <br /> Boiler Dnnkin Founlain <br /> Refri eialion Floordrain <br /> Woodstove Grease tra <br /> Ducting Raof drains <br /> Oiher � Medicai Ga [i:unvac ouneis <br /> SPRINKLER I SUPPRESSION SYSTEM Omer'�4 oxygen outlets <br /> Number ol He:�ds Other <br /> I hCreDy cntlily th�t I�ave read end examinrd ihi5 appLGlbon intl know Ihe Same Io be irue and cortecl NI piov6mn:of 18�antl ortl�n�nces govemm9 <br /> llus Iype ol wnrk w!I�e mmplretl wi�h wtielher speoheU he�ein or nol. l�e granlinq ol a permd doe;nol O�esume to qrve aulhorily to violate or concel <br /> Ihe pmvision ol any olher slale o�lo[al law regulalin9 conslruclion or Ihe peAnrmanr.e ol r.onstruc6on Thal I am aut�onrrA by Ihr,ovmer ol lhis pro0ehy <br /> ��lo ped r Ihe work lor i¢ appM"I�o �s made antl I comply v+ilh Ihe Slale Coniraclr,r5 Law 1B 27 RCW�nd 79fi 200 W�C <br /> �� � �� _ .,wm.. <br /> Ow�r/ uthorized Agent Signatu e Dale (Revisetl2/:�7V <br /> I/Z <br /> �I_I� — v I��L <br />