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Elm <br /> ',IRE ALARM PERMIT APPIWATION <br /> CITY OF EVERETT PERMIT SERVIu S <br /> EVERETT SUBMITTAL INSTRUCTIONS: Drop off application and submittal documents at 3200 Cedar Street 2nd Floor Drop Box <br /> WASHINGTON CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 916 PACIFIC AVE-MAIN BLDG BUILDING AREA: sq ft <br /> PROJECT TYPE: ❑ NEW CONSTRUCTION III ADDITION Q✓ TENANT IMPROVMENT 7 REMODEL <br /> BUILDING USE: E SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑ MULTI-FAMILY-#OF UNITS: ITCOMMERCIAL <br /> PERMIT INFORMATION & DESCRIPTION OF WORK <br /> CONTRACT PRICE OF WORK: $85,000 ASSOCIATED ELECTRICAL PERMIT#(REQUIRED): <br /> DESCRIBE SCOPE OF WORK:RETROFIT OF FIRE ALARM SYSTEM. ALL PANELS AND INITIATING DEVICES WILL BE SWAPPED OUT. <br /> ALL EXISTING NOTIFICATION DEVICES WILL REMAIN AS IS. <br /> I <br /> PLAN REVIEW REQUIREMENT <br /> Plan review by the Fire Department is required prior to permit issuance.Confirm the required items are included by checking the boxes: <br /> Check the boxes below to indicaticate all documents that are being submitted with this permit application: <br /> ✓j 2 Sets of Specifications for the Devices to be installed (Equipment technical data sheets) <br /> 2 2 Sets of Plans-Must include the following: <br /> El Location of fire alarm devices <br /> 0 Battery calculations&voltage drop calculations for notification appliance circuits <br /> ❑r Sequence of operation in either an input/output matrix or narrative form <br /> . i <br /> • CONTACT INFORMATION <br /> OWNER NAME:PROVIDENCE HEALTH & SERVICES TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET91 6 PACIFIC AVE <br /> CITY EVERETT <br /> STATE WA ZIP 98201 <br /> 'OWNER PHONE:425-258-7854 OWNER EMAIL:LLOYD.CHRISTENSEN@PROVIDENCE.ORG <br /> 1-- <br /> 1CONTRACTOR NAME:CONVERGINT TECHNOLOGIES <br /> 1CONTRACTOR ADDRESS: STREET450 SHATTUCK AVE S SUITE 100 <br /> CITY RENTON STATE WA ZIP 98057 <br /> CONTRACTOR PHONE:425-591 5815 CONTRACTOR EMAIL:KEVIN.FREY@CONVERGINT.COM <br /> CONTRACTOR LIC.#(REQUIRED):CONVETL984BQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):42662 <br /> PRIMARY CONTACT: DOWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:KEV I N FREY CONTACT PHONE:425-591-5815 <br /> L CONTACT EMAIL:KEVIN.FREY@CONVERGINT.COM <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> 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 <br /> 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 <br /> 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 <br /> WAC. <br /> City of Everett Official Use Only <br /> Oi4it Ily sig ed by Koval Frey <br /> ora c.us PERMIT#: <br /> E K in.freySTc-n 7mt corn <br /> Kevin Fr. e Q-Kevergnt UU Prejec;klanager, <br /> �ifd Kevlttrrey 05.12.22 <br /> Peason:I have revie.ved th s <br /> Contact <br /> FA22o� - D I.L.Contact22.0 Kevin Frey I <br /> �ti?zezz.as.tz tr^7:3�-erno <br /> Owner/Authorized Agent Signature Date (Revised 4/21/2022) <br /> 1/7 <br />