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� APPLICATIO" FOR CONSTRUCTI''�N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259•8810 <br /> I I DEMOLITION I � COMBINATION i i BUILDING I 1 MECHANICAL X�TPLUMBING I"1 SIGN <br /> ONTlER MRIL�DDRE55 GITY ZIP PHONE <br /> Group Health Co-Op 521 Wall Street Seattle, WA. 98121 (206) 998-2372 <br /> TENMlT MFILA�DRESS CITY ZIP PMONE <br /> RRCNITECTORDESIGNEA MAILADDRE55 CITY 21P PNONE <br /> Group Health Co-Op <br /> GENERI1lCONTRACTOR MAIIADORE55 GiY ZIP PHONE STATELICENSEII <br /> Lease Crutcher Lewis 107 Spring St #500 Seattle, WA. 98104 (206) 622-0500 <br /> MECNRNIGALCONTRACTOR MAILAUDRESS CI1Y � ZIP PNONE � SiATELICEN5E1 <br /> Stirrett-Johnsen, Inc. 5555 Westgate Rd NW Silverdale, WA. 98383 (206) 692-6126 STIRRJ*281B6 <br /> PWMBIN6CONTRACTOR MMV�DDAE55 GIiY ZIP - PNONE STATELICENSEI <br /> (SdR10� ' <br /> CLASS OF WORK <br /> I�j{NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FFPI INSERT I�1 BUILD�NG RELOCATION <br /> $.300�OOO.OO CONTACi PERSON AN�PHONE NO. <br /> CONTR�CTPRICEOF\YOI1K Lee Stirrett (206) 692-6128 <br /> DESCRIBEWORKANOSOURiiEFOOTAGEINVOLVEO �Med Office 62,753 S � <br /> Plumbing Gara e - 92 117 SF <br /> PROPOSEDUSEOFBUILOING i HEiiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Medical Facility APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> LEGAL DES.^•RIPTION OF PPOPEPIY�SNOWN BEIOW OR A7tACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or___ e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> See� At'tached AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> _ __ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA'N 18.27 RCW AND 296200 WAC. <br /> X ���/�,�'YIA�'l� 6 • a9•93 <br /> PROJECTAUORES$ SqNAf NE OATE <br /> 2930 Maple Street, Fverett, WA. 98201 <br /> CnY Bu5�NE55lICENSE NO <br /> � PLUMBINO MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT FEE I <br /> .. 32 WATeR CLOSET(TOILET) 224 '00 A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � � <br /> 45 LAVATORY(WASH BASIN) 315 �00 UNIT HEATERS—B.T.U. M ; <br /> 2 SHOWER 14 '00 CLOTHESDRYERS � <br /> 1 KITCHE��SINK 8 DISP 7 �00 VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TFAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE i <br /> Z URINAL 14 '00 METAL FIREPLACE 8 CHIMNEY � <br /> 1 DRINKING FOUNTAIN 7 �00 FIREPLACE INSERT ; <br /> 4 FLOOR DRAIN 28 '00 HEAT PUMP � <br /> q BACKFLOW PREVENTERS 20 �00 GAS PIPING ' <br /> g ROOF ORAINS—RAINLEACERS 63 '00 EXHAUST FAN � � <br /> j2z SINK(.iERVICE—BAR,ETC.) 854 �00 ' <br /> 29 Gara e Drains 168 �00 � <br /> 1 Sand Oil interce ter 7 '00 ' <br /> � � <br /> SUBTOTAL $ 1,721 ;00 SUBTOTAL 5 ' <br /> PERMIT $ 20 �00 PERMIT $ � <br /> TOTALFEE $ 1 741 '00 TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FAONT SETB�CN ReAR SETBACK SIOE SETtfACK PLAN CHECK NUMBER FEE RELEIPT NO. <br /> USEZONE LOTAPEA VACANTSITE FEES VALUATION FEE <br /> BUILOING � i <br /> TYPEOFCONfS./ILOWABIE TYPEOFLONSi.AC1UAL o[cureucr No.aownurreuNnS � <br /> �"WP PLUMBING � � � <br /> -�---- <br /> 52EOFBLDG. NO.OFSTORIES OASEMENT MECHANICAL � - <br /> � <br /> i <br /> � <br /> GCGUPARCY LOAU FIBE SPRNKLEAS FEO'D HEIGHT LIMITATION ADOITIONAL PLAN CHECK � ^ <br /> � <br /> SPRINKIER � <br /> PEASON FOR SPRINKLERS � <br /> STA7E BUILDING SURCHAqGE i , <br /> INTAKEBY �'LANSAPPROVE06V CITYOFEVERETT PU�LICWORKS i <br /> LOCAL SALES <br /> TAX CODEIS 3105 TOiAL � � <br />