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FIRE IIPPRESSION PERMIT APPICATION 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 I(E)everetteps@everettwa.gov 1 (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2,t 0(j.J 4tJ.Q PARCEL#: D CITY aV.e.feSTATE L,J4 ZIP SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: U OWNER MAILING ADDRESS: STREET A)14 CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: E.AQ No(I G a d, p J a cc_4 1.0 Alt WA STATE CONTRACTOR LICENSE#(REQUIRED):1feL-10 F p 9,1.S"N�CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET-poAnx )3 025 CITY 17e3 JJ 7 STATE 1A)4 ZIP " gig g CONTRACTOR PHONE: i' yJ es EMAIL: /_-ie t‘L. pi ( I./ (`Z PRIMARY CONTACT: ❑OWNER ;CONTRACTOR ❑OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 112 S 0.7. 57 ' I e 1A 1'-oLL CONTACT EMAIL: He (` )Fite pm gp q�,r �•' (G�t� FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $ COO ASSOCIATED PERMIT#(if applicable): CI ,.00- — (Valuation shall include the prevailing fair mar/et value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: TYPE OF INSTALLATION:.4New Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑Water Suppression System-#of Heads: I C LiiChemical Suppression System -#of Heads: NOTE:Application must be submitted with 2 sets of plans,calcs,cut sheets,etc.See submittal checklist at everettwa.gov/permits 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Jo - 0S , l K Z V Owner/A h rized Agent Signature Date (Revised 2/8/2021) ") / Z