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PERMIT APPLICATIcI <br /> BUILDING / MECHANICAL / PLUMBING /SIGN'T'SPRINKLER/ DEMOLITION <br /> '1 /--PIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> M' 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: 1321 Colby Ave PROPERTY TAX#: 00438524600000 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Providence Health & Services TENANT NAME(If Commercial): Providence <br /> OWNER MAILING ADDRESS: STREET PO Box 24883 <br /> civ seattle STATE WA ZIP 98124 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Patriot Fire Protection, Inc. / <br /> / <br /> CONTRACTOR ADDRESS: STREET 2707 70th Ave F / <br /> CITY Tacoma STATE WA ZIP 98424 <br /> CONTRACTOR PHONE: 253-926-2290 CONT'I 1 R EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): PATRIFPn9.'G i/ / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024694 <br /> PRIMARY CONTACT: 0 OWNER IZI CONTRACTOR �1 jr�dj."R(Please Specify) <br /> CONTACT NAME: , I /.CONTACT PHONE: 253-377-2272 <br /> Matt Greene j� CONTACT EMAIL: matt@patriotfire.com <br /> , 13 -' `DING PERMIT APPLICATION;.; <br /> Existing Use of Building: hospital /', Contract Price of Work:$ 1856 <br /> Proposed Use of Building: ,/ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building'Type: ❑SFR-Detached ❑SFR-', ached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition 0 remodel ❑Repair ❑T.I. ❑Sign prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> add and relocate sprinklers for T.I. walls and ceilings V l L2o3 2 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> I. <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads 8 <br /> ACKNOWLEDGEMENT:1 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 1 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 /> Cit of Everett Official Use Only <br /> PERMIT#, 1 05 <br /> 44/04;e-,----t- <br /> �! � 7/26/17 l A'C ' " <br /> Owner/Authori d Agent Signature Date (Revised 5/20/2016) <br />