4201 RUCKER AVE COMMUNITY HEALTH CENTER 2022-10-07

uns 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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 4201 RUCKER AVE PARCEL#: 00582202200101 clry EVERETT STATE WA ZIP 98208 SUITE/UNIT#: N/A FLOOR#: 1 AND 3 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):COMMUNITY HEALTH CENTER CONTACT INFORMATION OWNER NAME:COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY OWNER MAILING ADDRESS: STREET4201 RUCKER AVE CITY EVERETT STATE WA ZIP 98208 OWNER PHONE:N/A OWNER EMAIL:N/A CONTRACTOR COMPANY NAME:FIRE SPRINKLERS INC WA STATE CONTRACTOR LICENSE#(REQUIRED):FIRESI*988RJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 047539 CONTRACTOR ADDRESS: STREET 1524 45TH ST E-SUITE 102 crrr SUMNER STATE WA ZIP 98208 CONTRACTOR PHONE:2538260099 CONTRACTOR EMAIL:HAYDENB@FIRESPRINKLERSINC.COM PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:2533417543 HAYDEN BAUMANN CONTACT EMAIL:HAYDENB@FIRESPRINKLERSINC.COM FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$29,846 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether ally paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure DESCRIPTION OF WORK: ADD AND RELOCATE SPRINKLERS AS REQUIRED FOR NEW WALLS AND CEILINGS. TYPE OF INSTALLATION: ❑New Suppression System ❑✓Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑✓Water Suppression System-#of Heads:107 ❑Chemical Suppression System-#of Heads: NOTE:Application must be submitted with 2 sets of plans,talcs,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# HAYDEN BAUMANN 2/07/2022 K z.Z®2—^®®3 Owner/Authorized Agent Signature Date (Revised 2/8/2021) i/2.