10821 19TH AVE SE PNW PHYSICAL THERAPY 2019-07-25

PERMIT APPLICATION /1414%,/:--a BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: e'O 8 Z; 19th Ave SE Ste 102 Everett, WA 98208 PROPERTY TAX#: 00574700200109 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Walter&Crow Testamentary Trust TENANT NAME(If Commercial): PNW Physical Therapy LLC OWNER MAILING ADDRESS: STREET 10500 NE8th St Ste '1900 cm, Bellevue STATE WA ZIP 98004 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: David CompanyLLC CONTRACTOR ADDRESS: STREET 19128 112th Ave NE Ste 2-433 CITY Bothell STATE WA ZIP 98011 CONTRACTOR PHONE: 206-999-3457 CONTRACTOR EMAIL: kelly@davidcompanyllc.com CONTRACTOR LICENSE#(REQUIRED): DAVIDCL831113 CITY OF EVERETT BUSINESS LICENSE#(REQUI D): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR P'OTHER(Please Specify) Designer CONTACT NAME: CONTACT PHONE: 206_9993457 Kelly Newbold CONTACT EMAIL: kellyadavidkdesignslIc.com BUILDING PERMIT APPLICATION Existing Use of Building:Class B Occupancy Contract Price of Work:$62,000.00 Proposed Use of Building: Class B Occupancy Heat Source: ❑Gas OElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: LECommercial ❑Industrial Type of Project: New ❑Addition 8 emodel ❑Repair OT.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: )4".":) New non bearing partitions, doorardware ASSOCIATED BUILDING PERMIT#(if applicable): y 22 F MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION 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 I PERMIT#IN'act - c0r4- yam