4201 RUCKER AVE COMMUNITY HEALTH CENTER 2022-10-07

• I E FIRE ALARM PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SITE INFORMATION _ PROJECT ADDRESS: \" 1 k(�1 �i( \(f . BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION Eg TENANT IMPROVMENT ❑ REMODEL , BUILDING USE: 0 SFR ❑TOWNHOUSE El DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: 11 COMMERCIAL PERMIT INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ \1,1 t MO `" ASSOCIATED ELECTRICAL PERMIT#(REQUIRED): DESCRIBE SCOPE OF WORK:.-\\YI { \\CA-cf\51) 4 fi.t '\SNtil A— L � k J PLAN REVIEW REQUIREMENT Plan review by the Fire Department is required prior to permit issuance.Confirm the required Items are included by checking the boxes: Check the boxes below to indicaticate all documents that are being submitted with this permit application: ❑ 3 Sets of Specifications for the Devices to be installed (Equipment technical data sheets) ❑ 3 Sets of Plans-Must include the following: ❑ Location of fire alarm devices ❑ Battery calculations&voltage drop calculations for notification appliance circuits ❑ Sequence of operation in either an input/output matrix or narrative form • CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME(If Commercial): '; . ( �XC Cj OWNER MAILING ADDRESS: STREET kk,S-2 ` k 1 _ CITY �1 �41,2- l STATE \� !✓�; ZIP , )?). OWNER PHONE: " b OC OWNER EMAIL: • CONTRACTOR NAME: CA‘AcA 6,((),A CONTRACTOR ADDRESS: STREET O1tt%2't _ :4 _ CITY 1:,a4.,`,I STATE ZIP ( CONTRACTOR PHONE:C(110 W 17'-kq (CONTRACTOR Ca (RCC,a\`V W i 't- ( C c CONTRACTOR LIC.#(REQUIRED):[ C1)t. . 2).ti- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 12)4 ' PRIMARY CONTACT: ❑OWNER [CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Vc\kii) Lail) *414' 0'6=[1\. L\t/� :' •:� CONTACT EMAIL C��L \(> � ...AZi xt \t � ft I i ((1-�l) t r. qti 1 � AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That 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 296.200 WAC. City of Everett Official Use Only PERMIT#: (0.1), .-,\� . I FAZ2_ 03 - 0@ ) Owner/Authorized Atnt Signature Date (Revised 4/15/2019)