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silo PERMIT APPLICATION
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<br /> BUILDING/MECHANICAL I PLUMBING I SIGN I SPRINKLER/DEMOLITION •
<br /> EVERETTCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> {B)>►e O, '.B1i`c1. .If k Ofif`PleaIe) .M4f.R.t gitA ,SITE Ii ,FOR fl .. ..'.`.M; .,.,.. a.. ..�', M . .,..�, ,,.....�.
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<br /> PROJECT SITE ADDRESS: ft, WA 98201 tPROPERTY N TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision I') l 65 t r 11 ,4ijt Lot No. (attach copy of long legal description)
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<br /> OWNER NAME:Providence Regional Medical Center TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: . STREET 10230 NE Points Dr.
<br /> csTvSeattle sTATEWA ztp98033 .
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME:Burns Fire Protection Systems. Inc.
<br /> CONTRACTOR ADDRESS: STREETP.O. Box 1110
<br /> any Granite Falls, STATE WA • zip 98253
<br /> CONTRACTOR PHONE:360-691-2235 CONTRACTOR EMAIL:Adminasst@burnsfire.com
<br /> CONTRACTOR LICENSE#(REQUIRED): BURNSFP84I DU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054660
<br /> —FRIM"ARY-CONTACT:—ETOWNER— CONTlACToR—❑-OTHER-(Please Specify)
<br /> CONTACT NAME:Keith Kyle CONTACT PHONE:425-905-5780
<br /> CONTACT EMAIL:Adminasst@burnsfire.com
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<br /> Existing Use of Building:Hospital Contract Price of Work:$30,50Q
<br /> Proposed Use of Building: Heat Source: OGas CI Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Unitt�s::/1 ISiommercial ❑Accessory Structure
<br /> Type of Project: CI New addition ❑Remodel CI Repair ❑T.I. ❑Sign lASprinkier CI Demolition CI Change of Use
<br /> DESCRIPTION OF.WORK:Burns Fire to modify existing wet sprinkler system in new pharmacy remodel area and
<br /> to add and relocate pendent heads as required.
<br /> e-1ASSOCIATED BUILDING PERMIT#(if applicable): �� ) �� I
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<br /> fill ,0000 A 00MIV�"PUC 1 O* a7L'#.L n.i+.^a'3 ,7}int' i o....�i�<1F Bt RMtrsAP" �Ct ,+.1. i i:V;.k'l ..:,.,,1 F/'1
<br /> FFixture Fixture
<br /> Ciount List of Fixtures Fixture List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> CouNC-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)
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<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior 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/011 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 /> r SP )N R10104:01.08000:00;252 Sewage Ejector or Sump Pump Other:
<br /> • Water Suppression System No.of Heads 4h,
<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 WAC.
<br /> a City of Everett Official Use Only
<br /> kt& . V /1 l PERMI'M�ts— on
<br /> Owner/Authorized Ag t Signature Date (Revised 4/15/2019) 1
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