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FIRE SUPPRESSION PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETTSUBMITTAL 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 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 30 s <br />PARCEL #: / 0 <br />CITY <br />STATE ZIP <br />SUITE/UNIT #: D FLOOR #: <br />ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): Fgc&jj11a <br />' <br />CONTACT INFORMATION <br />OWNER NAME: y I - <br />OWNER MAILING ADDRESS: STREET /o/ <br />CITY <br />STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR COMPANY NAME:] <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />Z)rZ <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): `Z <br />CONTRACTOR ADDRESS: STREET <br />-�' <br />CITY-wtq�2, <br />STATE ZIP <br />CONTRACTOR PHONE: . 63 Z--7 UZ evk244CONTRACTOR <br />EMAIL: <br />PRIMARY CONTACT: ❑ OWNER X CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />S lC"����� <br />CONTACT PHONE: ,5 /_ &&5/ Z <br />CONTACT EMAIL: <br />FIRE SUPPRESSION PERMIT INFORMATION <br />VALUATION OF WORK: $ YLAy—j 'C-kb <br />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 <br />❑ADU ❑Multi -Family - # Units: [Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: <br />c..�n10 � U�ISi7� f'�iY2Gi t�orl� <br />afFit.� S/�n�rtlr.Ge-I'S <br />TYPE OF INSTALLATION: ❑New Suppression System <br />Additions/Alterations to existing suppression system ❑Other - Describe above <br />TYPE OF SUPPRESSION: ,Water Suppression System <br />- # of Heads: ❑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. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />y T?- oC) <br />(Revised 21812021) <br />