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FIRE S•PRESSION PERMIT APPLID ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS: See applicable submittal checklist for submittal requirements and number of copies required for review, <br /> WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ell STREE ifeetie-effl M Loity 50 G PARCEL#:'50.5/8oc D7q op <br /> ew/Zen- CITY STATE LA,/4- zIP qs e <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): ©/ympjC ,L/c7c <br /> CONTACT INFORMATION <br /> OWNER NAME: gi-4D e-ue-lop'YLPXI f- ?roper t--1 L.LC_ <br /> OWNER MAILING ADDRESS: STREET (0oZ0 0259nd P/ NE <br /> Zarnaticl CITY STATE (,JP4 ZIP 98053 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: 1412.cHte- h^uc i.-) , inG • <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): IRRr-!"lE\ Z101DQ�'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3(7/ <br /> CONTRACTOR ADDRESS: STREET 7g55 3 ao( 5 - <br /> Atvl k-cITY STATE (A)SI' ZIP c/6032 <br /> CONTRACTOR PHONE: ao(.0-571-(olpla CONTRACTOR EMAIL: kn,GI4v® ch C 4-5frcdd e.:Y7 •C_GYIN <br /> PRIMARY CONTACT: ❑OWNER E,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c20(0, " S 71'W 6o/oZ <br /> CONTACT EMAIL: e.1n®0.rcar\erc. rmliwkicnrl carve <br /> FIRE SUPPRESSION PERMIT INFORMATION <br /> VALUATION OF WORK: $ 7/e15 ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ►:Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> I401cl ' !'eloc-k- c,,r 5pr trk-Li.rS vrtmcxlale, rt <br /> TYPE OF INSTALLATION: ❑New Suppression System Additions/Alterations to existing suppression system ❑Other-Describe above <br /> TYPE OF SUPPRESSION: *Water Suppression System-#of Heads: Q . ❑Chemical Suppression System-#of Heads: <br /> NOTE:Application must be submitted with 2 sets of plans,calcs,cut sheets,etc.See submittal checklist at everettwa.gov/permits for further information. <br /> 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 <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 I 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 /> City of Everett Official Use Only <br /> PERMIT# <br /> 4409/ 2-1 04 -00 <br /> Owner Authorized Agent Signature Date (Revised 2/8/2021) <br />