1321 COLBY AVE 4TH FLOOR 2022-04-27

11101111111111 FIRE SUPPRESSION PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1321 Colby Avenue PARCEL#: 00438524600000 CITY Everett STATE WA ZIP 98206 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Providence Regional Medical Center CONTACT INFORMATION OWNER NAME:Providence Regional Medical Center OWNER MAILING ADDRESS: STREET 1321 Colby Avenue cITY Everett STATE WA ZIP 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Western States Fire Protection WA STATE CONTRACTOR LICENSE#(REQUIRED):WESTESF 1 36QF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 20553 CONTRACTOR ADDRESS: STREET14690 NE 95th St, Unit 101 cm, Redmond STATE WA ZIP 98052 CONTRACTOR PHONE:14253052680 CONTRACTOR EMAIL:Daniel.Wilke@wsfp.us PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:14253052680 Daniel Wilke CONTACT EMAIL:Daniel.Wilke@WSfp.us FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $10,930 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work.whether actually paid or not.) BUILDING TYPE: ❑SFR Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure DESCRIPTION OF WORK:Construction in two phases, sections of the ceiling grid to be removed. Relocate sprinklers as indicated / required. TYPE OF INSTALLATION: ❑New Suppression System ❑✓Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ✓❑Water Suppression System-#of Heads:8 ❑Chemical Suppression System-#of Heads: NOTE:Application must be submitted with 2 sets of plans,calcs,cut sheets,etc.See submittal checklist at everettwa.gov/permits for further information. 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# K� to ci 01 t 1itiwvf 1/' is'\. 9/22/2021 Owner/Authorized Agent Signature Date (Revised 2/8/2021)