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4004 COLBY AVE 2019-03-14
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4004 COLBY AVE 2019-03-14
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Last modified
3/14/2019 10:32:38 AM
Creation date
3/14/2019 10:32:35 AM
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Address Document
Street Name
COLBY AVE
Street Number
4004
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PERMIT APPLICAT1011— <br /> BUILDIN 1ECHANICAL/ PLUMBING /SIGN _—RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits • <br /> (Blue or Black Ink Only Please) . PROJECT SITE.INFORMATION, <br /> PROJECT SITE ADDRESS: 4004 Colby Avenue PROPERTY TAX#: 0041130110290000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic <br /> OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave. <br /> CITY Everett STATE WA Zip 98201 <br /> OWNER PHONE: 425-328-6825 OWNER EMAIL: mgriffith@everettclinic.com <br /> everettclinic.com <br /> CONTRACTOR NAME: The Everett Clinic <br /> CONTRACTOR ADDRESS: STREET 3901 Hoyt Ave. <br /> CITY Everett STATE WA zip 98201 <br /> CONTRACTOR PHONE: 425-328-6825 CONTRACTOR EMAIL: mgriffith@everettclinic.com <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 9 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE'4255-328-68255 S %S <br /> Mike Griffith CONTACT EM L: mgriffithAeverettclinic.com •..r('te <br /> BUILDING-'PERMIT APPL N 4;;® <br /> Existing Use of Building:Medical Office building Contract Price of Work:$40,000 <br /> Proposed Use of Building:Medical Office building Heat Source: ❑Gas 0Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: laCommercial 0 Industrial <br /> Type of Project: CI New ❑Addition EtRemodel CI Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Interior work only, no exterior work. The project consists of remodeling 402sf into a staff lounge, utility <br /> Iroom and office. New work to include metal stud partitions, casework,flooring, some-newrPili_ ac ssv to s and4ig1 and <br /> minor modifications to electrical and mechanical systems. Modifications to Fire-Life Safety systems as required by new work. <br /> Fire-Life safety permit to be deferred submittal. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION „F , <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of #°f List of Fixtures List o Fixtures #of List of Fixtures #°f List of Fixtur s <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units eat Pump Toilet Backflow Pre er(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) nking 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 Drye 'ookups Other: Clothes Washer Medical Gas <br /> Range Ho Water Heater Other: <br /> Exhau an Sink(Servi ar/Mop/etc.) Other: <br /> S INKIER/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.lam the owner,or lam 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 /> KlAa)4 ILUsS Pic 'dt6 <br /> O97.1"kikkt-- <br /> uthorized Agent,Slyre_ L yA to (Revised 9/23/2016) <br />
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