1818 121ST ST SE 2019-08-20 - Laserfiche WebLink

OLT— PERMIT APPLICATION 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: 1818 121st Street SE PROPERTY TAX#: 28053000102400 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, Scott Lawson OWNER MAILING ADDRESS: STREET 3901 Hoyt Avenue CITY Everett STATE Y�'1n/ A ZIP 98021 OWNER PHONE: 425-259-1162 OWNER EMAIL: slawson@everettclinic.com CONTRACTOR NAME: The Everett Clinic, Mike Griffith CONTRACTOR ADDRESS: STREET 3901 Hoyt Avenue CITY Everett STATE WA zIP 98021 CONTRACTOR PHONE: 4255-328-6825 CONTRACTOR EMAIL: mgriffith@everettclinic.com CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)of CONTACT NAME: CONTACT PHONE: 425-328-6825 Mike Griffith CONTACT EMAIL: mgriffith@everettclinic.com BUILDING PERMIT APPLICATION .47 Existing Use of Building: Business Medical Clinic Contract Price of Work:$ 5 7 006 Proposed Use of Building:Business Medical Clinic Heat Source: ❑Gas ❑Electric CI Other _______ Building Type: ❑SFR-Detached ❑SF -Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial Type of Project: ❑New ❑Addition Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: The project consists of renovations and alterations to an existing medical clinic in an existing building. No exterior work. Interior work to include removal of non-bearing walls, construction of metal stud walls, minor modifications o existing ceiling and some new ceiling and lighting. new cabinetry to be installed, and some areas to receive new paint and flooring. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPPCATION "Type of Project: _New _ Addn Alteration Repair Type of Project: _New _Addn Alteration _Repair #of List of Fixtures #of List of Fi res #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures NC—Air Handling Units Hea ump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems nit 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 okups Other: Clothes Washer Medical Gas Range Ho Water Heater Other: Exhau an 2 Sink(Service/Bar/Mop/etc.) Other: S INKLER/SUPPRESSION SYSTEM 1Chemical 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 b•ing 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 .- .y ith he •i. tractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Of �1,o4. j 7. Il D O0� J Owner/Authorized Agent Si•-,'"-re Date ( ed 9/23/2016)