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PERMIT APPLICATIc; ' <br /> '11P.41//07'"ti BUILDIO I MECHANICAL/ PLUMBING /SIGMPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> i � f 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 Only4Please) P,ROJECT,SITE INF:,ORMATION F :=i <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 /> cm( seattle STATE WA zip 98124 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Patriot Fire Protection, Inc. <br /> CONTRACTOR ADDRESS: STREET 2707 70th Ave F <br /> CITY Tacoma STATE WA ZiP 98424 <br /> CONTRACTOR PHONE: 2553-926-2290 CONTRACTOR EMAIL: <br /> - - <br /> CONTRACTOR LICENSE#(REQUIRED): PATRIFPng9CF CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 024694 <br /> PRIMARY CONTACT: ❑OWNER II CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-377-2272 <br /> Matt Greene CONTACT EMAIL: matt@patriotfire.com <br /> 1:,:,-24,144:44,144-44:4q 4 ' -BUILDING=PERM(T APPLICATION <br /> Existing Use of Building: hospital Contract Price of Work: • 18556 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached`" ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CIT.!. ❑Sign prinkler :'emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> add and relocate sprinklers for T.I. walls and ceilings LilS bart 4.0K. ` jr ^ibt5 <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of 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/'SUPPRES ,IONS y.,TEM <br /> Number of Hea.s 15 <br /> ACKNOWLEDGEMENT:I have reviewed this..plication an 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 grantin.of a perm' only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under an ircu :tance.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 1.. .ly with the State Con actors Law 18.27 R r and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 11/9/17 PERMIT# ' — <br /> 0 5)(1.,, <br /> Owne Aut o d Agent Signature Date (Revised 5/20/2016) <br /> ( Z <br />