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PERMIT APPLICATIOt <br /> BUILDING�'.tIIECHANICAL I PLUMBING I SIGN IIIPPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • 44-77- 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:3927 Rucker Ave, Everett,WA. 98213 PROPERTY TAX#: 00411300501300 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: HEALTHCARE PARTNERS RE LLC TENANT NAME(If Commercial): The Everett Clinic <br /> OWNER MAILING ADDRESS: STREET3901 HOYT AVE, EVERETT,WA 98201 United States <br /> CITY Everett STATE WA zip 98201 <br /> OWNER PHONE:(425)259-0966 OWNER EMAIL:communication@everettclinic.com <br /> CONTRACTOR NAME: Patriot Fire Protection, Inc. <br /> CONTRACTOR ADDRESS: STREET 2707 70th Ave E <br /> c ITY Tacoma STATE WA ZIP 98424 <br /> CONTRACTOR PHONE: 253-926-2290 CONTRACTOR EMAIL:jared.heit@patriotfire.com <br /> CONTRACTOR LICENSE#(REQUIRED): PATRI FPO99CF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024694 <br /> PRIMARY CONTACT: ❑ OWNER E CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(253)926-2290 <br /> Jared Heit CONTACT EMAIL:jared.heit@patriotfire.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $1450 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: IgiCommercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ElT.I. ElSign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ADD/RELOCATE FIRE SPRINKLERS FOR T.I. WALLS & CEILINGS. <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> S ER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWL GE NT:I have reviewed this 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 granting of a permit 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 circumstance. 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 /> PERMITS#/1� 0 J �n <br /> ; 08/14/2019 L/� <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />