11109 16TH AVE SE 2022-07-13 - Laserfiche WebLink

FIRE S•PRESSION PERMIT APPLIsATION 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 11109 16th Ave SE PARCEL#: 28051900403400 cm. Everett STATE WA zip 98208 SUITE/UNIT#: FLOOR#: I ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Silver View Senior Apartments CONTACT INFORMATION OWNER NAME:Everett Housing Authority OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE:425-329-3338 OWNER EMAIL:megh@evha.org CONTRACTOR COMPANY NAME:Ap0110 Mechanical WA STATE CONTRACTOR LICENSE#(REQUIRED):APOLLMC864JQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 45197 CONTRACTOR ADDRESS: STREET3051 E Valley Rd cm.Renton STATE WA ZIP 98057 CONTRACTOR PHONE:206-430-0581 CONTRACTOR EMAIL:stephanie.carrero@apollomech.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) , CONTACT NAME: CONTACT PHONE:206-430-0581 Stephanie Carrero CONTACT EMAIL:stephanie.carrero@apollomech.com FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$2000 ASSOCIATED PERMIT#(if applicable): (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: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑✓Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure DESCRIPTION OF WORK:Relocate one dry head in storage room per Everett Housing Authority TYPE OF INSTALLATION: ❑New Suppression System ❑✓Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑✓Water Suppression System-#of Heads:I ❑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/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 lam authorized by the owner of this property to perform 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 P �L#Zoe .O o—k 04/11/2022 Owner/Authorized Agent Signature Date (Revised 2/8/2021) //z