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PEkMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />1019 112th Strret SW <br />3AL LOT NO. BLOCK <br />PARCEL TAX I.D. # <br />I 00442900102501 <br />TRACT <br />i2. —aO�D6 <br />ERMIT p <br />!/ 1 7_ 1 / <br />Community Health Center P. O. Dox 13060 F.verett, 9�206 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />Community Health Center <br />CONTRACTOR <br />Smith I•'ire Systems <br />CONTR. LICENSE p <br />St9ITilI•'51360T <br />USE OF BUILDING <br />Medical cencer <br />WORK DESCRIPTION <br />� Diane Hinton <br />ADDRE55 <br />381J 168th St. N�, Suite 1 <br />HEATSOURCE <br />Eleciric Gas <br />Install fire sprinkler syetem ( 721 Ilea�ls ) <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR IT[M <br />Toilo� <br />Bathlub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink & dispa;nl <br />Dishwasher <br />Clolhes washcr <br />W atar hoatar <br />Sink (sorvicc/badmophdc-) <br />�ackflow preventor <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Gr�ase �rap <br />Roof drains <br />Olhm — ___ _ . _. <br />360-651-7701 <br />CITY2IP PHONE <br />Arlington, 9A221 360-G51-7701 <br />CONTRACT PRICE OF WORK <br />Olher I 571,498.u0 <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water hea�er <br />Gas fireptace <br />Gas rango <br />Clothes dryor <br />Rangehood <br />Exhaustlan <br />Heal pump <br />Unit hoalor <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY Of EVERETT LOCAL SALES TAX CODE IS J105 <br />I heroby cerility ihal I have read and examined lhis applicalion and know Ihe same lo be lrue and correcL All provlsions ol laws and <br />ordmaces �overniny Ihis lypa uf work will bo complied with who�hor spocilied horein or nol The granting ol a permil does nol presume <br />to pivr aulhorily lo vinlato or cancol Iho provision of any olher state or local law regulatinp conslruction or ihe pnrformance of <br />consiruclion. Thal I am authorized by the ownor of this pruperty to porform Ihe work for which applicalion fs made and I wmpty wilh Ihe <br />StelF Conlractors Law 1�27 RCW and 29G.200 WAC. <br />J � 12-15-06 <br />�,...�.,...1— .t„�er.'� <br />