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• • <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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� ww�ni.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1201 WG'tfTlOre Av@, Everett WA 98206 PROPERTY TAX#: 00409423000100 <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � I TENANT NAME(If Commercial): The Everett Clinic, ATTN: Scott Lawson <br /> OWNER MAILING ADDRESS: s,zEe- 3901 Hoyt Ave <br /> arv Everett ;rarE WA ziP 98201 <br /> owNER PHONE: 425-259-1162 OWNER EMAIL: slawson@everettclinic.com <br /> CONTRACTOR NAME: The Everett Clinic <br /> CONTRACTOR ADDRESS: srReeT 3901 Hoyt Ave. <br /> c�rY Everett ;rnre WA Zio 98201 <br /> CONTRACTOR PHONE: 425-259-1162 CONTRACTOR EMAIL: slawson@everettclinic.com <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �/] OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-259-1162 <br /> Scott Lawson CONTACT EMAIL: slawson@everettclinic.com <br /> BUILDING PERMIT APPLICATION �� ✓ <br /> Existing Use of Building: Outpatient Clinic Contract Price of Work:$ f— <br /> Proposed Use of Building: Outpatient Clinic Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Q1T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Modification of an existing medicai clinic. Work is limited to the pharmacy area. Work to include new partitions, doors&finishes <br /> wit modi ications to e ectrical, plumbing and HVAC system Electrical, plumbing and HVAC to be submitted under a deferred <br /> submittaL —""—� � • <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 ��f List of Frxtures �°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fiztures <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(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENL 1 have reviewed this applicafion and confirm fhe information contained herein is true and correct Woric done pursuant to this permit must compty with <br /> current federal,sfate,and local law The gran6ng of a permit only aufhonzes approved work and no deviations therefrom.Devrafions must first be authonzed in�roriting from fhe <br /> Building Official before being authonz`tl under any circumstance 1 am the owner,or I am aufhorized by the owner of this property to perform the work for which application Is made, <br /> and I compfy wifh State Cor t rs L�27 RCW and 296 200A WAC <br /> Ciry of Everett O�cial Use Only <br /> / ' ,�' PERMIT � �� <br /> / .� <br /> OwnerlAuthorized Agent ignature Date (Revised 9/23/ 16) <br /> j� � <br />