1100 PACIFIC AVE EVERETT BONE AND JOINT 2018-12-14

PERMIT APPLICATION BUILDIN(�►IECHANICAL / PLUMBING / SIGN�RINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICE 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 1 OO PaCIfIC AV2 PROPERTY TAX #: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: TENANT NAME (If Commercial): Everett Bone and Joint OWNER MAILING ADDRESS: srReer 1100 Pacific Ave CITY Everett STATE WA ziP 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Burns Fire Protection Systems Inc. CONTRACTOR ADDRESS: srReeT PO Box 1110 aTv Granite Falls srnrE WA ziP 98252 CONTRACTOR PHONE: 425-239-2698 CONTRACTOR EMAIL: keith@burnsfire.com CONTRACTOR LICENSE #(REQUIRED): 953,986-01- CITY OF EVERETT BUSINESS LICENSE #(REQUIRED�: 54660 PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: K21th Kyl@ CONTACT PHONE: 425-239-2698 CONTACT EMAIL: keith@burnsfire.com BUILDING PERMIT APPLICATION Existing Use of Building: Medical Clinic Contract Price of Work: $ 4,400.00 Proposed Use of Building: No change Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial TypeofProject: ❑New ❑Addition ❑Remodel ❑Repair �(T.I. ❑Sign ❑Sprinkler ❑Demolition ❑ChangeofUse DESCRIPTION OF WORK: Burns Fire Protection Systems to add and relocate fire sprinkler heads to meet new wall and room layout to be in compliance with NFPA standards. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair # of List of Fixtures #�f List of Fixtures # of List of Fixtures # of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C — Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: SPRINKLER / SUPPRESSION SYSTEM Zo Number of Heads ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 irom the Building Officia/ before being authorized under an circumstance. I am the owner, or 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 La�a 1� R�Y4�and 296.200A WAC. Owner/Authoriied Agent Signature 03/10/2016 Date City of Everett Official Use Only PERMIT # '� � ��G �� ;��-�� (Revised 10/12/2015)