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E FIRE SUPPRESSION PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review,
<br /> WAS H1Ne370t1 then drop off completed application plus all required submittal documents to 3200 Cedar Street2nd Floor Intake Drop Box,
<br /> CONTACT INFORMATION;(P)425,257.84101(E)everettapsi ievereltwa.gov J(W)everethve,eovtperrnits
<br /> (Blue or Black Ink Only Please) PROJECT' SITE INFORMATION
<br /> PROJECT.SITE AD RESS: Ern r
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<br /> SUITE/UNIT#: FLOOR#: i ADDITIONAL LOCATION INFORMATION:
<br /> TENANTIBUSINESS NAME(if non-residential): ,. , a�,.. _, .�"-4,E / t c . ,,. c t ,,„�• � .,.+ ,
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<br /> CONTACT INFORMATION
<br /> OWNER NAME: i ki e,, f , i L-r _ ,-n ,(. {ie", 1—>-t5 ri s
<br /> OWNER MAILING ADDRESS: slaw; a ny " y` it 2 '2 6 t.,e
<br /> ::I74 rye , .r=' ,_ STA,ec .C,y.T,`-„ ".a+' ."`+"--r',..
<br /> OWNER!HONE: ' A!", -A.e OWNER EMAIL;
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<br /> CONTRACTOR COMPANY NAME: '" rZ .
<br /> 'WA STATE CONTRACTOR LICENSE#,;REQUIRED) ; ,7•t:+";:'"; :, '7' ,;„#i" c TY OF EVERETT BUSINESS LICENSE ti(RECGUlRED):� , "- 7
<br /> CONTRACTOR ADDRESS: STREET 4°(3) .film,,,,r,,. - ..q-
<br /> CITY ._777,-,/, /# STATE j4^7,, ;P• .,r er ,-- Y..
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: "4 pe;".„z. �. ,` ;;. .,.ems ? yrr,: , t°m,
<br /> PRIMARY CONTACT: DOWNER "CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT'NAME: CONTACT PHONE: , 4z. - l 7 - ;'f• -c
<br /> I' ;r 11., , "' -:',4. - „"S CONTACT EMAIL; f .Y"" T—" a,=,✓mot ` r_ .` ,
<br /> FIRE SUPPRESSION PERMIT INFORMATION,
<br /> VvA mar LUATION OF the WORK: g lag mowaelan/abet n ilr anal c trparaASSOCIATED
<br /> rnpeto T#A(if applicable):
<br /> needed to SAiTt{'i to lase work,woueinet CWetly Nei'of Pol.)
<br /> BUILDING TYPE: 0SFR [Townhouse ElDijpieX DADU ®Multi-Family-#Units: T ,, ., ❑Commercla1 DAcc ssosy Structure
<br /> ,DESCRIPTION OF WORK:
<br /> TYPE OF INSTALLATION: El New Suppression System A.dditionsiAlterations to exzstirrj suppression system ❑ather-Describe above
<br /> TYPE OF SUPPRESSION: [water Suppression System-#of Heads; [Chemical Suppression System-#of Heads
<br /> NOTE:Applic�tliwn amust be strbmvtted with 2 sets of plans.,€.abets,cut sltetti,ntte.See submittal checithst at everettwa. ou pettnits for furthrn inforr tion,
<br /> ACKNOVi EOGEMENT.•I hame haveived this appkoation and corrfrrrn the inforroshon contained heseJn is true end correct.letbric done pwrstisrrt to tfes Writ must COrt*swth
<br /> currant tedderat,state. and toed taw.The granhmg of a pernad oPly authorizes approved work end no dernaki/to therefrom,Coviatioms etust first be authorized in ssrattop trona the
<br /> Butting Offciat before being aldrhatized under any Circumstance.t am the cower or r am authohsed by the owner of ties property to perforrn the wor*(or which eopeicetkm is made,
<br /> and t coot*rrtrr the Sate Contractors Lew t 8,2 z ROW and 295.2004 WAG,
<br /> City 0/Everett tt OOtltcva.i test Ortbr
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<br /> L „ PERMIT
<br /> Ownc Authorized A Wotan* Date (Reviso 'Z'&'202l) `
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