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PERMIT APPLICATION I I. <br /> /11111°''04//44 -----a <br /> BUILDINGS-ICHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> 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 1 www.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1321 Colby Ave PROPERTY TAX#: 004.38524600000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Health Services WA TENANT NAME(If Commercial): Verizon <br /> OWNER MAILING ADDRESS: STREET 1801 Lind Ave SW <br /> crw Renton STATE WA ZIP 98057 <br /> OWNER PHONE: 425-261-3746 OWNER EMAIL: peter.smeltz@providence.org <br /> CONTRACTOR NAME: LEGACY - r � MMvN!�A-n oiS ,111 <br /> CONTRACTOR ADDRESS: STREET fPQ soXjjao A <br /> CITY 1)RLE y STATE N/A ZIP 918- <br /> CONTRACTOR PHONE:(15 g(o —77111 C. ' TOR EMAIL: <br /> CONTRACTOR LICENSE • REQUIRED): LE67.4&T 1 00 5 k2 'ITY OF EVERETT BUSINESS LICENSE#(REQUIRE',):Q'924lc I <br /> PRIMARY CONTACT: 0 OWNER ■ •` - OR MOTHER(Please Specify) Consultant <br /> CONTACT NAME: CONTACT PHONE: 425-530-2945 <br /> Les Cooley CONTACT EMAIL: les@sage i com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Hospital Contract Price of Wo :$ 17,600.00 <br /> Proposed Use of Building: Hospital Heat Source: ❑G DElectric ■ 'ther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units. ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ISIRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler 'emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Exchange 9 antennas for 9 new antennas, exchange 3 RRU's (remote radio units) for <br /> 3 new RRU's and exchange 6 diplexers for 6 new diplexers per plans <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 /> 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.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.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 I comply with the State Contractors w 18.27 RCW and 296.200A WAC. <br /> 11/28/17 PERCI 3,3 <br /> City of Everett Official Use Only <br /> t <br /> Owner/Authorized Agent Signature Date II ) ' (Revi ed 9/23/2016) <br />