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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/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 I www.everettwa.gov/permits <br /> (Blue or.Blak Ink Only Please) ,4".? PROJECT SITE-INFORMATION? <br /> PROJECT SITE ADDRESS: 916 Pacific Avenue PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Health and Services TENANT NAME(If Commercial): Fr: L /yelp,,-1pr(,.u atka- <br /> OWNER MAILING ADDRESS: STREET 600 Broadway, Suite 304 J j <br /> CITY Seattle STATE WA ZIP 98122 <br /> OWNER PHONE: (206)215-3531 OWNER EMAIL: James.Grafton@providence.org <br /> CONTRACTOR NAME: Ferris-Turney General Contractors, Inc. <br /> CONTRACTOR ADDRESS: STREET P.O. Box 30119 <br /> CITY Seattle STATE WA ZIP 98103 <br /> CONTRACTOR PHONE: (206)632-2797 J CONTRACTOR EMAIL: rod@ferris-turney.com liO( ' o1 1414 <br /> 4 <br /> CONTRACTOR LICENSE#(REQUIRED): �� ���G`C N 1, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) •t l.4 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Architect . <br /> CONTACT NAME: Devin Saylor CONTACT PHONE: (425)259-0868 <br /> CONTACT EMAIL: .devin@bnharch.com <br /> BUILDING PERMIT APPLICATION_ ;{ <br /> Existing Use of Building: Hospital (Outpatient Clinic) Contract Price of Work:$ 60,000.00 <br /> Proposed Use of Building: Hospital (Outpatient Clinic) Heat Source: KIGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition I%IRemodel ❑Repair ❑T.l. OSign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: Minor tenant improvement remodel of an existing outpatient clinic location in the existing hospital. <br /> �t&I ,Pleer <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION 1 PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—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.I am the owner,or I 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 Law 18.27 Re and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � ,C <br /> LZ 10-23-2017 a to —6`I a <br /> Owner/Authorized Agent Signature Date (Revised 9 3/2016) <br /> 411, <br /> r ' <br />