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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 /> SITEADDRESS:916 PaCIfICAV21lU@ -�'`",'�`' PROPERTYTAX#29O'rJ3OOOZOO�OO RMIT# �`� <br /> �t�;�"C1 �I .���-�-C�- , -� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> owNER Providence medical center Pnone,E-ma;, knelson@hermanson.com <br /> Address 916 Pacific Avenue City/State/Zip Everett, WA 98204 <br /> APPLICANT: Owner Owner's Agent �Contractor Contractor's Agent T@f1211t(must provide a letter of consent from the owner to do work in[he space) <br /> CONTRACTOR Hermanson Company State Lic.# HERMACL005BJ c�ty BUS. u�.# 037262 <br /> Add�ess 1221 2nd Avenue N Kent, WA 98032 Pno�e�Err�ai�206-963-5097 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Providence Kaylene Nelson <br /> Pno�e�E-ma�� 206-963-5097 knelson@hermanson.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK �3�5,156 <br /> Existing Use of Building �I� �'����t ��-�' HEAT SOURCE: <br /> Proposed Use of Building NO Challge Gas� Electricn Othern <br /> Building type: DSingle Family a Du IexaTownhouse D 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 /> Provide and install 7 toilets, 40 hand sinks, 1 kitchen sink, 1 dishwasher, 2 hot water tank and 1 sink <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New ddn Alteration epair Type of Project: NewaAddn Alteration❑Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handlin units 7 Toilet <br /> ' Forced air s stems ' Bathtub <br /> I 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 /> i Exhaust fan Sink service/bar/mo /etc. <br /> � Heat um ' Backflow reventer <br /> ' Unit heater Urinal <br /> Boiler 3 Drinkin Fountain <br /> Refri eration i Floor drain <br /> Woodstove ; Grease tra <br /> Ductin � Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM 2 otner: Hot water tank <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know lhe same to be We and correct.All provisions of laws and ordinances governing this type otwork will be compi <br /> with whether specifed herein or not.The granting of a permit does not presume to give authonty to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authonzed by the owner of this property to perform the work for which application is made and I comply with the Sfate Contractors Law 1827 RCW and 296200A WAC. <br /> ��'�%1 r'1��.�'� �)�s;'�'1 K��ti�1 ��1,�,' �����'� c�.��`-� ��'I� <br /> Owner/ thorized Agent Signature Date (Revised 9/2014) <br />