Permit D06-456 - Objective Medical Assessments Corp - Tenant Improvement

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CITY OF TUKWILA.) Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http: / /www.ct tukwila. wa. us Building PertutNoo Mechanical Permit No Plumbing/Gas Permit 1 Public Works Penulth Project No oroce use only) Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** King Co Assessor's Tax No.: Site Address: .49/ 6T7241/Zt/., so Suite Number: J% Floor: Tenant Name: (' ryi6r. 42va4?n/ e4 'j/74o/94 (17) New // Tenant r .... Yes 0..No Property Owners Name- c/� /PAG. Nn S 41e �K/-te n.o c.R. n . 1 . Mailing Address: CONTACT PERSON - who do we contact when your permit is ready to be issued .; Name: Tyl-F er), ® / Mailing Address: 4/ // ‘ 7 atti ie 34. e C 4 ; A, 7 City � E -Mail Address: 57a iny7 . CO/77 Contact Person: E -Mail Address: Contractor Registration Number: Contact Person: E -Mail Address: Contact Person: E -Mail Address: Q: Applicatiwu\orm.-Applieniwu On Line U3006 - Permit Application.doc Revised: 9-2006 sh City State Zip Day Telephone: 4'3 aj( e9 rei.0 4ii9 S7?/R3r State Zip Fax Number: 576 _ /65S am GENERAL CONTRACTOR INFORMATION - , �i (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: Mailing Address: City Day Telephone Fax Number: State Expiration Date: ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record Company Name: Mailing Address: City Day Telephone: Fax Number: State Zip Zip ENGINEER OF RECORD - Alt plans must be wet stamped by Engineer of Record Company Name: Mailing Address: City Day Telephone: Fax Number: State Zip Page 1 of6