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477 III PERMIT APPLICATION • BUILDING / MECHANICAL / PLUMBING / SIGN I SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT.WA 98201 (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION °� PROJECT SITE ADDRESS: 1280 t'`� /`�i e 5' PROPERTY TAX#: � 3 t O I 7 7O LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Providence Regional Medical Center Everett TENANT BUSINESS NAME(Commercial): Mill Creek Campus Echo Room OWNER MAILING ADDRESS: STREET 1321 Colby Ave ciTv Everett STATE WA ZIP 98206 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:Burns Fire Protection Systems, Inc CONTRACTOR ADDRESS: STREET PO Box 1110 cm, Granite Falls STATE WA ZIP 98252 CONTRACTOR PHONE:360-691-2235 CONTRACTOR EMAIL:audra@burnsflre.com CONTRACTOR LICENSE#(REQUIRED):BURNSFP841 DU CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 54660 PRIMARY CONTACT: ❑OWNER 1p CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-905-5780 Keith Kyle CONTACT EMAIL:keith©burnsfire.com BUILDING INFORMATION Existing Use of Building:Medical Contract Price of Work: $575 Proposed Use of Building:Medical Heat Source: ❑Gas DElectric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial ❑Accessory Structure Type of Project: New ❑Addition ❑Remodel ❑Repair ❑✓T.I. Sign Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Burns to relocate Fire Sprinkler heads to new Ceilings and provide code compliant coverage from current location on new flex drops. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer _ Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop ,Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb _Urinal Exhaust Hood(Type Ill Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System F. No.of Heads Chemical Suppression System No.of Heads 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 11(// r 9-15-2021 _I PERMIT#K.21 D Q —003 Owner/Authorized Agen/,'AI,t/ gnature Date (Revised 10/10/2018)