215 DORN AVE CD 2022-01-24 - Laserfiche WebLink

FIRE OPPRESSION PERMIT APIOICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHINGTON then drop off completed application plus all required submittal documents to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P)425.257.8810 (E)everetteps@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2.fl s p T / PARCEL#: CITY v,eJ'e.-tt STATE W4 ZIP SUITE/UNIT#: C FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: U OWNER MAILING ADDRESS: STREET Ai 14 . CITY STATE ZIP OWNER PHONE: OWNER EMAIL:l CONTRACTOR COMPANY NAME: ke 10 0 rt.de 0 ,104 ec.+ t O AJ WA STATE CONTRACTOR LICENSE#(REQUIRED):/feLTo p9i c'N�CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET"p©7,1 13 0 5 s CITY Oe.c-1 epi^u t JJ C� STATE J,J4 ZIP g1 C( 8 CONTRACTOR PHONE: CONTRACTOR EMAIL: pie `s.4- f°t fe_pd0 /y. v1 Syz PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) _...—.. ✓/ CONTACT NAME: CONTACT PHONE: L.f 2 5- Li II_5 7 81 C® CONTACT EMAIL: rie rriat1��P tar0 n �• C G n4^ FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$ CJj oot ASSOCIATED PERMIT#(if applicable): Li 2c-3 OC (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ESFR ❑Townhouse 'Duplex ❑ADU ❑Multi Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: S-famv( ,tUou 2 e . • �54c CtI�- C 4iPv 5,(siemi P•e-' 2✓FfA L3--D -41 I- f fk-write -f TYPE OF INSTALLATION: . New Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑Water Suppression System-#of Heads: 17 ❑Chemical Suppression System - #of Heads: NOTE:Application must be submitted with 2 sets of plans,talcs,cut sheets,etc.See submittal checklist at everettwa.gov/perrnits for further information. 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 from the Building Official before being authorized under any circumstance.l am the owner,or!am authorized by the owner of this property to pet-form the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# VD-4- 0(5.- - Owner/A rized Agent Signature Date (Revised 2/8/2021)