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

PERMIT APPLICATION (7:00214r— RWHIV" 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 WA '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: 425-328-6825 CONTRACTOR EMAIL: mgriffith@everettclinic.com CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-328-6825 Mike Griffith CONTACT EMAIL: mgriffith@everettclinic.co • BUILDING PERMIT APPLICATION ` r/ Existing Use of Building: Business Medical Clinic Contract Price of Work: , 00. 6 V V . Proposed Use of Building:Business Medical Clinic Heat Source: ❑Gas ❑Electric IN Other Building Type: ❑SFR-Detached ❑SF -Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition El 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 .fa - 7 • •- . -•, • • - • - . • •- -.. .. • .. ASSOCIATED BUILDING PERMIT#(if applicable): -- MECHANICAL PERMIT APPLICATIOl PLUMBING PERMIT APCATJ01t Type of Project _New Addn Alteration f pair Type of Project: _New _Addn AI - ation Repair #of List of Fixtures #of st of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtu NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater • Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basi Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink:.Disposal Grease Trap Gas Range Ducting Dishwash- Roof Drains Clothes Dryer Hoo Other: Clothe , asher Medical Gas Range Hood Wa Heater Other: Exhaust Fan 2 k(Service/Bar/Mop/etc.) Other: SPRINKL - /SUPPRESSION SYSTEM Chemi or Water ' 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 C.1471394,ith he . - -. tractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ---------") iy � 1� /1. PER k.... ._tv - d( G J Owner/Authorized Agent Si re Date (Revised 9/23/2016) CIO