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PERMIT APPLICATIO <br /> BUILDINmIIECHANICAL/ PLUMBING /SIGN I 'RINKLER/ DEMOLITION <br /> '1111P#40 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (BIi e o Blas t►iljOnly Please-j" 41,_ P,RQ. ECr§ROOF RM TTIQNI <br /> PROJECT SITE ADDRESS:900 Pacific Avenue Everett,Washington PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER NAME: Providence Children's Center TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 900 Pacific Avenue <br /> CIT,, Everett STATE WA. <br /> ZIP 98201 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: McKinstry <br /> CONTRACTOR ADDRESS: STREET 5005 3rd Avenue s. <br /> crry Seattle STATE Washington zip 98124 <br /> CONTRACTOR PHONE: (206)763-4819 CONTRACTOR EMAIL: Permits@McKinstry.com <br /> CONTRACTOR LICENSE#(REQUIRED): MCKINCL942DW CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ):049226 <br /> rte.. .,- ,,. .,, .._„ .rye . .. ,,,, . 4,,. , ___ „- ..,.„. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (206) 763-4819 <br /> Jim Thomas • CONTACT EMAIL: Permits@McKinstry.com <br /> � : - .... .r ” BU104,10 FERMI A Pt:IC'OrtiNI jr1 t <br /> - <br /> Existing Use of Building: Contract Price of Work• $ 10,500.00 <br /> Proposed Use of Building: Heat Source: OGas ❑ElecJcic�❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Jot D..0 15 -a' 9/714kt - #61.45 ro-r- Cep <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 700. CA7"ION UOPWI r ` 4 PLlMBINc ERMIT AP „- <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC–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 /> ;.,..,.k ,SPRIN*LER I SUPPRESSIQN SYSX' EM <br /> 5 Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit 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 authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER IT <br /> OO� c CC.0 1(111& �A(.0 —oC ( — <br /> ^ner/A thorized Agent Signa ure Date (Revised 9/23/2016) <br />