3927 RUCKER AVE BASE FILE 2018-02-23

• PERMIT APPLICATION BUILDING I :'!i`!CHANICAL / PLUMBING / SIGN / INKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICELi 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 3927 Rucker Ave. PROPERTY TAX#: 00411300501300 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Don Stacey TENANT NAME (If Commercial): Everett Clinic OWNER MAILING ADDRESS: STREET 3927 Rucker Ave. -.- CITY Everett STATE WA ziP 98201 OWNER PHONE: 425-328-6829 OWNER EMAIL: dstacey@everettclinic.com CONTRACTOR NAME: Viking Automatic Sprinkler CO. CONTRACTOR ADDRESS: STREET 3434 1st Ave. S. CITY Seattle STATE WA ZIP 98134 CONTRACTOR PHONE: 206-622-4656 CONTRACTOR EMAIL: zack.brown@vikingsprinkler.net CONTRACTOR LICENSE#(REQUIRED): VIKINAS373NT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):024704 PRIMARY CONTACT: ❑ OWNER V1 CONTRACTOR El OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-622-4656 ?ack/Vince CONTACT EMAIL:Zack.brown@vlkingsprinkler.net BUILDING PERMIT APPLICATION Eating Use of Building: Medical Clinic TI Contract Price of Work: $ 1300.00 Proposed Use of Building: Medical Clinic TI Heat Source: ❑Gas ❑Electric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 0Commercial ❑Industrial Type of Project: ❑New ZAddition ❑Remodel ❑Repair DTI. ❑Sign EI Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Add Fire Sprinkler Head to "G-3" Elevator Lobby ASSOCIATED BUILDING PERMIT#(if applicable): 1 MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair w' #of List of Fixtures #of 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 _-=-r- 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 1 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 OW:rent 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 t Butlding 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 mads and/comp h th e State Contractors Law 18.27 RCW and 296.200A WAC. f City of Everett Official Use Only , ,e. it_ yii/i 7 PERMIT# � dQ/0(1Ow er/ uthori. d Ag:nt Signature D (Revised 9/23/2016)