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PERMIT APPLICATION <br /> BUILDINGIMECHANICALIPLUMBINGISIGNISPRINKLERIDEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett,WA 98201 425-257-8810 FAX 4?.5-257-8857 ww�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Q —o�S —�Z <br /> SITE AD�RESS: 431 D COLBY AVE, SUI E 203 PROPERTV TAX tl ,?ERM�X <br /> EVERETT, WA 98023 00582202600200 �j — <br />� LEGAL lor new conslrucUon. Snort PlaVsubdivision N/A Lot No._ (attach copy of long le�al descnption) <br /> OWNER P�TERSEN-rIILDAHL LLC Phone/E-mail (425) 637-1875 / GENE.HILDAHL@GMAIL.COM <br /> /+de�ess 210P 112TH AVE NE Ci�ylstate2ip BELLEVUE WA 98004-2945 <br /> APPLICANT:_Ovmer X Owner'sAgeN Contractor ContractofsAgent _Tenanilm�s���o,�oeawne�oicov�-ii•cnmee+ne�iuno.o�k��iroe�uu•) <br /> CONTRACTOR PACIFIC ALLIANCE CONSTRUCTION �&i�;c.p PACIFAC944RK coE Bus. �ic.u 049138 <br /> nddress 1124 EASTLAKE AVE EAST, SUITE 202 Phonc:[ma�l (206) 689-0515 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> WESTERN WASHINGTON MEDICAL GRP. HERBERT BAKER, SABARCHITECTS <br /> Phone/e-mau (206) 957 6400 x204 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �54,000 <br /> Existing Use of 6uilding 81 HEAT SOURCE: <br /> Proposed Use of Buildinp B� Gas Electnc X Other_ <br /> Building type: _Single Family _Duplez_Townhouse _Mulli-Family X Commercial <br /> Type of projecC New Addition Remodel Repair X T.L Si n S rinkler Demolilion Chan e of Use <br /> DESCRIPTION OF WORK(addr�iona�spaco provided on�he 6ack): <br /> TENANT IMPROVENiENT, DEMOLITION AND CONSTRUCTION OF NON STRUCTURAL INTERIOR WALLS ON THE <br /> TI�IRD FLOOR OF AN EXISTING MEDICAL CLINIC. NO EXTERIOR WALLS OR STRUCTURE WILL BE P40DIFIED. <br /> MECHANICAL, ELECTRICAL, PLUM9ING AND f IRE SAFETY WILL BE COVERED UNDER SEPARATE I'ERMITS. <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProjecC _New_Addn _Altoration_Repair Type of ProJecl: _New_Addn _AlteraUon_Repair <br /> Show Numbei(MJ o/lixfules Show Number(N)o/lixtures <br /> A!C—airhandlin unils Toilet <br /> Forr,ed air s stems Balhtub <br /> Gas pipin Lavatory(xash basin) <br /> Walen c�aler Shower <br /> Gas fire iace Kitthen sink 8 dis osal <br /> Gas range Dishwasher <br /> Clolhes d er Clothes washer <br /> Ran e hood Waler healer <br /> Exhnust fan Sink(service/badmopletc. <br /> Heat pum Backflow preventer <br /> Unit heater Urinal <br /> Boiler DrinY.in Founlain <br /> Re(ri eralion Flnor drain <br /> W oodstove Grease lrap <br /> Ductinq Roof drains <br /> Othcr Medical Gas <br /> SPRINKLER ! SUPPRESSION SYSTEM oth��r. <br /> Numbcr of Heads Other: <br /> I he�r Lry ceni/y that I��ve reaC ond examined U's epFlsabon antl know the same to be Irue nnd cortecL All provisions ot laws antl oMMances govem�nB lhis type ol work wL'I be mmpl�e� <br /> .�:�tli vd�ether epecReC herein or nol The granW B of a pertn:l dces not presume to grve auRionry m vioia!e o�wr.ccl the provis�on o/any ciher state or bcai iaw rega'a:'�ng constructbn <br /> That 1 am aul�orizetl Ly Ihe owner cl lhi9 propetly�o pertor.n�he work ior whkh epD���p^is��a0e ontl 1 romply wnh the Stale Contradors La�.v 78 27 RCW and 29610JA WhC..11� <br /> "r�f���f' f- ''""�`z� ������/� Revised 6R012/ <br /> OwnedAuthodzed AgenlSignature Dalc � <br />