8609 EVERGREEN WAY COMMUNITY HEALTH CENTER 2018-10-25

4ren- PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits (Blue or Black Ink Only Please) �! PROJECT SITE INFORMATION PROJECT SITE ADDRESS: c 10 6 9 J�c,F�Co�f--C_d3 J' ( PROPERTY TAX#: 2- C.)1-1/3 O)OOC=) 3 3�-j LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: CO M H. U PFJ cri i 1✓� T NANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: kj (AU(. -eC-61k) 0 c- 1 (TUL) C--o- ; -T- - CONTRACTOR ADDRESS: STREET 3'300 CR-LC-1 V s (t j 0 ( ��, CITY j�J GL. i A (.' ` STATE ZIP CONTRACTOR PHONE: 1Z r)..-c-`j'-I( {( CONTRACTOR EMAIL: �Lt ,,Q��[ ✓l al, .(:SWI-- CONTRACTOR LICENSE#(REQUIRED):IJ acC (S,1' ?.j T2 L )CITY OF EVERETT BUSINESS LICENSE#(REQUIRED:: b'%O'(IV PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: BUILDING PERMIT APPLICATION $ y Existing Use of Building: Contract Price of Work: $ ! d0 0 Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Us,\e DESCRIPTION OF WORK: - -reet Ai IOP B c K fc- ,{ i 69 / X Li )) ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Number of Heads ACKNOWLEII EMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with current feder• state,and local law. Th-grantin,•of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Bulking Offic. before being authoriz:d under a y circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and comply th the State Contract.s Law 18. 7 RCW and 296.200A WAC. IF City of Everett Official Use Only PERMIT# 1/9 4 - (b ' 61 (0 (0` 0(q Owner/Authorized •:ent Signature Date (Revised 5/20/2016)