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��, • • <br />PERMIT APPLICATION <br />BUILDWG / MECHANICAL ! PLUMBiNG ! S1GN ! SPRI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425 257 8810 I FAX 425-257-88�7 I(E) everette s@everettwa ov j <br />NKLER / DEM�L1TlON <br />- - p .g wv�nN.everettwa.govlpermits <br />CONTACT INfQRMATION <br />QWNER NAME: PaCific Ave, Assoc. LLC TENANT NAME (If Commercial): �verett BOne and Joinf <br />QWNER MAILING ADDRESS: sTREer 1100 PACIF{C AVE <br />cir EVERETT srn� WA z�P 98201 <br />OWNER PHONE: �425) 339-2433 pWNER EMAIL: - <br />CONTRACTOR NAME: Matt Newland <br />CONTRAC70R ADDRESS: srReeT 3300 Chestnut Street <br />cin, Everett sra-re WA zia 98201 <br />CONTRAC70R PHONE: (425) 876-4645 CONTRACTOR EMAIL: matt@newlandcompany.com <br />CONTRACTOR LICENSE #(REQUIRED): GITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CQNTRACTOR � OTHER (Piease Specify) Designer <br />CONTACT NAME: Manaf Shawish CONTACT PHONE: (425) 252-2153 <br />CONTACT EMAIL: manal@2812architecture.com <br />BWLDING PERMIT APPL:ICATION <br />Existing Use o` Buifding: Medical Office Contract Price of Work: $ 31 fl,OG0.0 <br />Proposed Use of Buildin : Medical O�ce Heat Source: �Gas ❑Efectric ❑dther <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Muiti-Family-# of Units: �Commercial ❑Industrial <br />T pe of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air �T.I. ❑Sicn ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTIO(V OF WORK: Interior improvements to the second and third Floor of the Evereit Bone and Joint building. The tenant improvements <br />involve modification of the reception area and the billing room as wefl as the addition of some casework in the exam <br />rooms on the third floor. The addition of a break room, billing room, and lockers rooms on the second floor. <br />AS50CIATED BUILDING PERMIT # if a licable : <br />PLUMBMNG PERMIT APPLICATION <br />Type of Pro}ect: _New Addn Alteration Repair <br />#°f List of Ffxtures #°f List of Fiztures <br />Fixtures Fixfures <br />Toilet Backflow Preventer (Inside Bldg) <br />eathtub Urinal <br />l.avatory (Wash Basin) Drinking F'ountain <br />Shower Floor Drain <br />Kitchen 5ink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Wafer Heater Other: <br />Sink {Service/BarlMopletc.) Other: <br />ACKNOWLEDGEMEN7" ! have reviev✓ed this applica!ion and confirm the information centained herein is true and correct. Work done pursuant to this permit mus! comply wrih <br />current �ederal, state, and local /aw. The granting of a permit only aufhorizes approved work and no deviations therefrom. Deviations must frst be authoried in �Nrrting from the <br />8uildrnq O(ficial before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of fhis properiy to perform the work for which application is made, <br />and ! comply with ihe Siate Contractors Law i8.27 RCW and 296.200A WAC. <br />Ci(y of Everett Official Use Only <br />PERMIT _' � , j , <br />c..�-a > L�—_-- J ��� <br />11.24.15 l 6 <br />Owner/Authorized Agent Signature Dato (Revised 1/92/2095) <br />` `� <br />