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• <br /> INN <br /> ire FIRE SUPPRESSION PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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 I(E)everetteps@everettwa.gov (W)evereftwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: maser 33^3.2 +E( P4& j Way PARCEL#' 112203 <br /> :J Zc c c/IS <br /> cm e1i't Q 'I; • STATE \/ A zP <br /> SUITEIUNIT#: FLOORS: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): 6- ‹.Aft,gt C t.JA L-os corvieADgEs, <br /> CONTACT INFORMATION <br /> OWNER NAME EVeR r/ $1-.-4 FAVA S Ito rt' s7 PIf(. <br /> OWNER MAILING ADDRESS: STREET "i3',i ` 164t AvE Ara - 5L.t,tTE P-J.�D <br /> CITY pee,modui, STATE CA)14 ZIP <br /> OWNER PHONE: !OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: ,a l.,L_ A CAW (i a f P/2o1EC-ri o 1J ((VC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):ALA MAP 954-Q,f CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):QL 3 36 6 <br /> CONTRACTOR ADDRESS: STREET lb ox 'l 3 <br /> CnV 10' -,QE'g-" STATE (.4 A ZP /le,0a jp <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:t"(I4.4cP{G —*1'`d 461'CC) tn" <br /> PRIMARY CONTACT: O OWNER ,6CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: Ic,E . N (,1, H A,M CONTACT PHONE: xi 2 5' . 2 4$ 351 <br /> CONTACT EMAIL: aktavitor.ica feea 30(,4o,n <br /> FIRE SUPPRESSION PERMIT INFORMATION <br /> VALUATION OF WORK:$ 4*ff 00 0 -^ ASSOCIATED PERMITS(if applicable): N / A <br /> (Valuation shall indude the prevailing fair tharket value of al labor,materials,and equipment needed to complete the work,whether actually paid or not) <br /> BUILDING TYPE: DSFR OTownhouse ODuplex OADU ❑Mufti-Family-#Units: Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: ", V g t 6C ca t .-,L I` l k A C) W S <br /> (QEill 3 CC& A c cywi Dsa. • t eE $d cnve+t E <br /> kt) tAFAc"+ c.Ae .z_. 5 pf-c-t FtCc c1o, L - 12,Ei <br /> t . isc,h) AND LINK 4-b tms t Al . 'Tor tAL3Cs c 1` S lAj <br /> TYPE OF INSTALLATION: ❑New Suppression System tions/Alterations to existing suppression system OOther-Describe above <br /> TYPE OF SUPPRESSION: OWater Suppression System-#of Heads: Chemicai Suppression System-#of Heads: 13 <br /> NOTE:Application must be submitted with 2 sets of plans,caks,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 Ls true and correct,Work done pursuant to this permit must comply with <br /> current federal,state,and kcal law.The granting of a pemait only authorizes approved work and no deviations therefrom.Deviations must first be authorized/n writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official use art, <br /> PERMIT# <br /> $/2- 202.4 KezIpq -- 4o I <br /> rizad Agent signature Date (Revised 2182021) <br /> yz_ <br />