3927 RUCKER AVE 2ND FLOOR 2019-04-17

PERMIT APPLICATIO BUILDIN�AECHANICAL/ PLUMBING /SIG RINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue'or Black Ink,Only Please)` P ECT SITE INFORMATION„ PROJECT SITE ADDRESS: 3927 Rucker Ave. PROPERTY TAX#: 0041 1300'5501300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: The Everett Clinic TENANT NAME(If Commercial): The Everett Clinic OWNER MAILING ADDRESS: STREET 3901 Hoyt Ave. CITY Everett STATE WA zip 98201 OWNER PHONE: 425-328-6825 OWNER EMAIL: mgriffith@everettclinic.com CONTRACTOR NAME: The Everett Clinic CONTRACTOR ADDRESS: STREET 3901 Hoyt Ave. CITY Everett STATE WA ZIP 98201 CONTRACTOR PHONE: 425-328-6825 CONTRACTOR EMAIL: mgriffith@everettclinic.com CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER pCONTRACTOR ❑OTHER(Please Specify) _.._,,....,-•-- CONTACT NAME: - CONTACT PHONE: - 2 ( Mike Griffith CONTACT EMAIL: mgriffith@everettclinic.com Existing Ude of Building:Medical office building Contract Price of Work:$30,000.00 Proposed Use of Building: Medical office building Heat Source: Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: l'Commercial ❑Industrial Type of Project: ❑New ❑Addition IaRemodel ❑Repair ❑T.I. DSign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Interior work only, no exterior work.The project consists of a remodel to the hand therapy room.One office will be demolished to make room for the remodel. New work will include metal stud partitions,casework,flooring,suspended ceiling system, lighting and minor modifications to electrical&mechanical systems. Modifications to Fire-Life Safety and fire suppression systems as required by new work. Mechanical, ASSOCIATED BUILDING PERMIT#(if applicable): electrical,fire-life safety and sprinkler permit to be deferred submittal. `MECHANICAPERMIT'APPLICATIOI�L,':3 ,. .: ` PLUMBING PERMIT APP,ILIIrAT10;N t,. .n. .<. ,. " .' ; Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER!SUPPRESSION,SYSTEM;;, Chemical or Water I No.of Heads 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 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 Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 1145 / / g PERMIT ,OLJ Owner- u horized Agerit Signa ure Dat �'j (Revise 9/23/2016) /--) / `�� '�`.1r-('/'mac