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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> l�Z--� <br /> SITE ADDRESS: PROPERTY TAX q PERMIT# <br /> L�a���. � 29053000200100 ��,� - -_� - <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> owNER Providence Everett Medical Center Phone/E-mail <br /> Address 916 Pacific Avenue City/State/Zip Everett, WA 98204 <br /> APPLICANT: Owner Owner's Agent Contractor Contractor's Agent Tenant cm�st p�o��ae a iener ot�or,5ern trom cr,e owr,er ro ao work�n me SPace� <br /> CONTRACTOR Hermanson Company State Lic.# HERMACL005BJ City Bus. Lic.# <br /> Address 1221 2ND Avenue N Kent, WA 98032 phone/Email kr1@ISOCI Q�II@ffTlallS011.COf11 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Colby Medical Center Kaylene Nelson <br /> Pno�e�E-rnai� 206-963-5097 <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 300,000 <br /> Existing Use of Building Comercial HEAT SOURCE: <br /> Proposed Use of Building NO Chaflq@ Gas� EiectricII Othern <br /> Building type: D Single Family a Du lex aTownhouse �Multi-Family �Commercial <br /> T e of ro ect: New Addition � Remodel Re air T.I. Si n S rinkler Demolition Chan e of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Renovate existing space on Level 2 of the Colby MOB. Reuse (15) existing VAVs , relocate (7) existi <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New ddn Alteration epair Type of Project: New Addn Alteration Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handlin units Toilet <br /> Forced air s stems Bathtub <br /> Gas i in Lavato wash basin <br /> Water heater Shower <br /> Gas fire lace Kitchen sink&dis osal <br /> Gas ran e Dishwasher <br /> Clothes d er Clothes washer <br /> Ran e hood Water heater <br /> Exhaust fan Sink service/bar/mo /etc. <br /> Heat um Backflow reventer <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease tra <br /> Ductin Roof drains <br /> Ly OtherVAV Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same ro be true and correct.All provisions of laws and ordinances governing this rype of work will be comp� <br /> with whether specifed herein or not The granting of a permil does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authori�edib�th owner o is p pe to p orm the work for which application is made and I comply with the State Contractors Law 1827 RCW and 296200A WAC. <br /> r,�� <br /> ' ; ` �l�l�� <br /> Owne rized nt g Date (Revised 9/2014) ti� <br /> U <br />