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PERMIT APPLICATION <br /> BUILDING / �CHANICAL / PLUMBING / SIGN / S�INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue orBlack tnk Only Please) PROJECT SITE:INFORMATION <br /> PROJECT SITE ADDRESS: 1 5 SW EV@P@tt MaII Way PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> owNEtz NAnne: Rosen Bel-Kirk Associates, LLC TeN,4NT NaMe(�f commerciaq: Molina Medical Management <br /> OWNER MAILING ADDRESS: sTReeT P.O. BOx 5003 <br /> c,n Bellevue STATE WA ziP 98009 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Tower Pacific Construction <br /> CONTRACTOR ADDRESS: srReET 302 W. Blackburn Road <br /> cirv MOUnt VernOn STATE WA ziP 982�3 <br /> CONTRACTOR PHONE: 360-424-6871 CONTRACTOR EMAIL: office@towerpacific.com <br /> CONTRACTOR LICENSE#(REQUIRED): TOWERPC018N3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER TLI CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 360-661-0837 cell <br /> Tom Toepfer CONTACT EMAIL:tomt@towerpaCific.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Medical Mgmt. Contract Price of Work: $40,000 <br /> Proposed Use of Building: no change Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: lC7Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ORemodel �Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Minor tenanl improvement lo the front Reception/VJaiting area.Remove existing non-bearing walls and reconfigure the reception and waiting area layouts.Includes:Melal slud,drywall,electrical,flooring and finishes <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the info�mation contained herein is true and correct. Work done pursuant to this pe�mit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being a orized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the Contra ors Law 18.27 RCW and 296.200A WAC. <br /> Ciry of Everett Official Use Only <br /> � �� / PERMIT#�` ��r� � � <br /> L L <br /> Owner/Authorized Agent Signature te (Revised 9/23/2016) l- 4 <br /> j � ; <br /> \ <br />