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APPLICATIOR FOR CONSTRUCTAN PERMIT{//�//p���fT <br />CITY OF EVERETT •BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />0 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 3901 IlOyt Avenue, Everett, WA 98201 <br />The Everett ni Cli90 Hovt A Fj[[pLCtt,_WA 9R201 (47S) 75q-[WRF <br />dNNFP MYL ApGPE55 CITY Zlr rMdlC <br />The Alleu:gv Clinic 3901 Hwt AvernEe ErTerett WA 98201 __ <br />TENANT MAN ApORE55 LIiY ZII rIgNE <br />Architectural Werks 11335 N8 122nd Way, Suite 140 Kirkland, WA 98034 1425) 8 a-77,14_ <br />ANCWTTCT d1 BEyd+EP MAN ARTINESS cm Zlr nNONF <br />Kirtley-cole Associates, Inc PO Box 1179, Snohomish, WA 98790 (u0) 5f8_317 _ <br />GENERAL CONTRACTOR MAD ADDRESS COY bl FgNF SIA,C LICENSE <br />MECHANICALCONTRAC,OA MAIADDRESS an ZIP PRME STAIF LgENSE, <br />PI IIMBMG CONTRACTGR MAIL ADDRESS Cltt Z./ PHWE $lA1E lgEHSF, <br />CW IMCt %1qE Or WGPN <br />loq?OJ <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />DESCPIBE MAX AND S.SWAPE FOOTAGE WVCLVEO <br />Tenant Improvement <br />CONtACiv[PSON ANp nNDNFW <br />Cole (unl RfJT_li •+, <br />I HERE Y ERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL RE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW IB 27 RCW AND 296.200 WAC. <br />X <br />INglgsfO USE of BDLdNG <br />LEGAL OEScdpnW a<vnGP[nrylLgwx BELOW GRAIIACN IWOcoVlE51 <br />LOT BLOCK or <br />PNgELTAXI D ,YFOO L R OO/ <br />CWSiRUYOim LOOAAN IENFn. ADDRESS. TEIEPHgNE NVAIER <br />SIGNATURE GAir <br />KlH f' A272AF <br />CITY SUSINI LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO, <br />F TYPE OFEGUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—A/HKOLG UNITS <br />BATHTUB <br />I FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />—�— <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTALFEE E <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FPONt SFipACM gEAq Bf1BM:I( SICE SE,BACR PI AN CRICK HAIRED FEE I nFCfIPF NO <br />I OI AREA VACANT SIZE <br />DIES D NO IRIANNG <br />HEIGHT IIMIATDN NO OF OWEWIq EIZE /W B.L�ONGTI, 0 , 7 <br />UNNS 1(�Q!/ -A= FLMMBNG <br />DIES NNO <br />FIRESFAINKLERREO'G <br />REASON <br />AMPONALMANCHRCK <br />no <br /><S vnccG aT riax,&,rF7 <br />OTFP <br />FIFE ALARM pW'p <br />/7o <br />PfASW yam{ <br />C �� 4/RLIB� ATbpr <br />SLAP BPpW RBRRCHMRF <br />TvvE or r.ONsr <br />nngs Arwgv[oer <br />CRY OF EVERETT <br />FREE IC WORKS <br />—Al%L <br />VGATE <br />t Z23 ki7 <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />