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FIRE 'PRESSION PERMIT APPLI•TION <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 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 43 //2,411 5J- S E PARCEL#: <br /> CITY r�i , rJ- STATE W ZIP 9 g2ote <br /> SUITE/UNIT#: FLOOR#: Ql"( �`. ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): FCLI-4-4-41.t 1 P(Z(s , j,Q/t't CCX-E. ( L.L; <br /> CONTACT INFORMATION <br /> OWNER NAME: ()oJ,: Yc-- <br /> OWNER MAILING ADDRESS: STREET ,y 3 n ,l 12' ¶ S e VT 9 <br /> CITY �� Q L-,�„f,_..�... STATE /A ZIP 2 <br /> OWNER PHONE: ! 4— l 7 3— b if OWNER EMAIL: /1, �,/ c G�/�C �C' rviat.'/ , c Q`� <br /> CONTRACTOR COMPANY NAME: M F;r P, pv..0 Q,vl Sy rt ri <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (03(81.4 <br /> CONTRACTOR ADDRESS: STREET `Z n 60 7 Qt <br /> CITY CT-r.k y1/t STATEkiti ZIP tg-22.) <br /> CONTRACTOR PHONE: Z< 5's�I_ti, .,• 94 CONTRACTOR EMAIL: 60-1)h,rrtofL tm 4-; 4 P 'le ro C.4-N1rt S<{'e <br /> PRIMARY CONTACT:4JWNER CONTRACTOR 1J)THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 20 7_ 1! q- 6o ( <br /> / i <br /> e c� ( - ) ra.}-t CONTACT EMAIL: 11 %e l.S C 'e . (.#mg.. .(f�I^✓ <br /> FIRE SUPPRESSION PERMIT INFORMATION Cl <br /> VALUATION OF WORK:$ 000. / 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:r FR ownhouse E)u lax DU Multi Family-#Units: Commercial CIccessory Structure <br /> DESCRIPTION 0 I r•RK: <br /> cis- `I `� to t�,��e,�or' <br /> \it Tc�-ec--Lit. 1NQ'vk V, s9.t-►-Q-I ' c3-E, <br /> TYPE OF INSTALLATION: Iew Suppression System Edditions/Alterations to existing suppression system Either-Describe above <br /> TYPE OF SUPPRESSION:LVater Suppression System-#of Heads: :hemical Suppression System-#of Heads: <br /> NOTE:Application must be submitted with 2 sets of plans,calm,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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / /Z0?2 PERMIT <br /> V(..),213 \__ <br /> V 6 <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br /> 6 <br />