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= PERMIT APPLICATION
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<br /> BUILDING/MECHANICAL/PLUMBING 1 SIGN /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 I www.everettwa.gov/permits
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<br /> PROJECT SITE AoDREsst.14004sitgatfterett. WA 98201 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision *321 (A1 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: STREET10230 NE Points Dr.
<br /> . cnySeattle STATEWA ZIP 98033
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME:Burns Fire Protection Systems, Inc.
<br /> CONTRACTOR ADDRESS: srREETP.O. Box 1110
<br /> c,n Granite Falls STATE WA ZIP 98252
<br /> CONTRACTOR PHONE:360-691-2235 CONTRACTOR EMAIL:AdminaSSt@bUrnSfire.Com
<br /> CONTRACTOR LICENSE#(REQUIRED): BURNSFP841 DU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):054660
<br /> —FRIMARY-CONTACTr D-OWNER—VICoNTRA roR—OrtYTHER-(Pleas'e-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:$
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: • ISkommercial ❑Accessory Structure
<br /> Type of Project: El New ❑Addition CI Remodel El Repair IOTA. ❑Sign 6 'Sprinkler ❑Demolition El Change of Use
<br /> DESCRIPTION OF WORK:Burns to modify sprinkler protection in phase 1 in existing area C sector level
<br /> Rest36,144 2 to conform with new ceiling plan.
<br /> ASSOCIATED BUILDING PERMIT# if a••licable r, t 1 . /V (_ 'f 4� i a n
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<br /> Fixture @Fixture Fixture
<br /> Count List of Fixtures �' List of Fixtures ount Count List of Fixtures Count List of Fixtures
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<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 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/Oil Water Service(behind meter)
<br /> Forced Alr Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> 24J'Jt .Elul s _ .01 '0:MatN' Sewage Ejector or Sump Pump Other:
<br /> • Water Suppression System RR o.of Heads
<br /> Chemical Suppression System No.of Heads.
<br /> ACKNOWLEDGEMENT*I have reviewed this application and confirm the information contained herein is five 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 1 comply with the State Contractors Law 18.27 RCW and 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> kel PERMIT# ioe 1
<br /> Owner/Authorized Ag nt Signature Date (Revised 4/15/2019)
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