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4rEn. PERMIT APPLICATIOII <br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:2707 Colby Avenue, Suite 718 PROPERTY TAX#:00439162500100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: DaVita Kidney Care TENANT BUSINESS NAME(Commercial): DaVita Nephrology Practice Assoc. <br /> OWNER MAILING ADDRESS: STREET32275 32nd Avenue <br /> cmv Federal Way STATE WA ZIP 98001 <br /> OWNER PHONE: 253.733.4830 OWNER EMAIL:KriStin.VidetO@daVita.COm <br /> CONTRACTOR NAME:Axiom Northwest Construction <br /> CONTRACTOR ADDRESS: STREET2232 Broadway, Suite 101 <br /> crry Everett STATE WA Zip 98201 <br /> CONTRACTOR PHONE:425.903.4038 CONTRACTOR EMAIL:jennifer@axiomnw.com <br /> CONTRACTOR LICENSE#(REQUIRED):AXIOMNC920LJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 054458 <br /> PRIMARY CONTACT: 0 OWNER ID CONTRACTOR 0 OTHER(Please Specify) General Contractor <br /> CONTACT NAME: CONTACT PHONE:425.903.4038 <br /> Jennifer Montana-Lopez CONTACT EMAIL:jennifer@axiomnw.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:OfficeContract Price of Work:$-120,000- - (�c�� 000 <br /> Proposed Use of Building:Office Heat Source: OGas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial EAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.l. Sign Sprinkler ✓❑Demolition EChange of Use <br /> DESCRIPTION OF WORK: The scope of this project is to demolition interior partitions in preparation for T.I. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): In process Plan Check NBo B1811-046 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C-Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry.mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System 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 RCW and 296.200A WAG_ <br /> Cityof Everett Official Use Only <br /> PERMIT# <br /> ,.." '' ,,,t . , "22,... <br /> /r;- k)h 5 73 ( g I -0 i' 5 <br /> Owner/Authorized Agent Signature D/te ! (Revised 10/10/2018) <br /> Z <br />