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0 <br />PERMIT APPLICATION � � �`� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT. WA 98201 /��� ) �` �.,- i.� <br />425-257•8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM A AM TO 4 PM <br />SITE AODRESS PARCEL TA% I.D. p <br />1019 112 TH STREET SW„ EV[RETT. WA 98104 004<29�010 2505 2504. 2503. �501 <br />LEGAL LOTNO. BLOCK TRALT <br />DESC y5 1 TRACT 25. BLOCK 1, FAIRMOUNT <br />COMMUNITV HEAITH CENTER OF SNOHOMISH <br />COUNTV <br />TENANT NAME <br />COMIdUNI7V HEALTN CENiER OF , <br />SNOMOMISM COUN7Y �'_� f �` � C� ��'� <br />CONi11ACTOR <br />i <br />J R A�BOLT ONS7RUCTION <br />ONTA, IICENSE M �RABBCI022 JZ <br />USE OF BUILDING <br />MCDICAL AND DENTAL CIINIC <br />' �-�� �� <br />/_ : <br />PERMIT A <br />SEPA t 05�066 <br />5929 EVERGREEN WAV, SUITE 200 EVERETT, 98303 <25� 249�IOJ4 <br />CONTACT FOR PERMIT PHONE <br />�RUCf HAYASHI OF SHARON KHOSIA 206�674�0177 <br />ADDRE55 CIiV21P PHONE <br />3512 AIRPOFT WAV SEATTLE.98174 206-467�8500 <br />HEATSOURCE <br />x Electnc Gas Other <br />WORK DESCRIPTION <br />CONSTRUCTION OF NE W?5 WO SF MEDICAL AND DENTAL CLINIC <br />PLUMBING <br />NO. I TVPE OF FI%NRE OR ITEM <br />� Totlet <br />Ba1hNb <br />X Lava�ory (wash basin� <br />Shower <br />X K^chen sink 8 dispos�l <br />� Dishvrasher <br />Clothes washei <br />Laundry tray <br />x Sink (servicefbarnnnp�rtc ) <br />X BackBow preventei <br />X Unnal <br />X Dnnking Foun�ain <br />% Flaor dram <br />Grease Irap <br />_ cL Rooldrams <br />� Other ci nnfl siNh-. _- __-- <br />CONTRACT PRICE OF WORK <br />3J 9 MILLION <br />NO. I TYPE OF FIl(TURE OR ITEM <br />�_ A/C - air handhnr� umis <br />�_ Forcedairsystems <br />� Gas p�ping <br />_� Water heater <br />Ges lueplace <br />Gas range <br />Clothes dryer <br />x Ra�gehood <br />_1L Exhaust fan <br />� Heat pump <br />�_ Unrt heater <br />Boiler <br />x RefngeraUon <br />Woodstove <br />CITV OF EVERETT LOCAL SALES TAX COUE IS 7706 <br />I hereby cenhly that I have read and eramined this apphca�on and know the same to be true and conect All provisions of laws and <br />� ordmaces govemmg Uns!yp� 01 work wdl be compheA with whether specdied herein or not The c7raMmg ol e permit does not prewme <br />' to grvr, authonty to wolate oi c I the pmvis�on ot any other slale or bcal law regulating construcllon or the peAnmiance o� <br />� construc6o�} That I vn auth d by Ihe owner of �his property tn perlorm the work lor wh�ch auphca�ion s made and � comply wdh ihe <br />' Sla�e Cor�fcro�s law iti CW and�('�200 WAC �! � <br />VI <br />