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477 PERMIT APPLICATIOI• <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1700 13th St Everett, WA 98201 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Regional Medical Center TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10230 NE Points Drive <br /> CITY Seattle STATE WA ZIP 98033 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Burns Fire Protection Systems, Inc. <br /> CONTRACTOR ADDRESS: STREET P.O. Box 1110 <br /> CITY Granite Falls STATE WA ZIP 98252 <br /> CONTRACTOR PHONE: 425-388-0124 CONTRACTOR EMAIL: Adminasst©burnsfire.com <br /> CONTRACTOR LICENSE#(REQUIRED): BURNSFP841 DU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 054660 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425-905-5780 <br /> Keith Kyle CONTACT EMAIL: Keith@burnsfire.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 20250.00 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ONew DAddition ❑Remodel El Repair ❑T.I. ❑Sign VSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Level 2 Phase 1 - Burns to modify sprinkler system to existing tower D Wing Level 2, to conform with new ceiling plan. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures _Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet _ Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler ▪Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater _Refrigeration _Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal _ Grease Trap <br /> Gas Range Ducting Dishwasher _ Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> • <br /> Exhaust Fan ▪Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPP SSIONSYSTEM <br /> Chemical or Water r� INNIm99.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed th 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 grant! of a per it 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 ' stance.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 /> City of Everett Official Use Only <br /> 1..�j 7 <br /> / 6 /1g PERMIT#�\6 ('n—_ I <br /> wner/Authorized gen ignature Daf6 (Revised 9/23/2016) <br /> 72M: <br /> , -� ! <br /> \ <br />