2216 127TH PL SE 2023-04-07 - Laserfiche WebLink

FIRE SOPRESSION PERMIT APPLaTION EVERETT CITY R SUBMITTAL INSTRUCTIONS:See applicableOF submittalEVERETT checklistPERMITSE 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 I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET' lb I L/ «I r L o C PARCEL#: U092 700000100 CITY 6 VeRETT STATE V V/`i ZIP !5b SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):TE M PE RLY'S LONG TERM CARE FAMILY HOME CONTACT INFORMATION OWNER NAME:ROSA BROUTZAKIS OWNER MAILING ADDRESS: STREET2216 127TH PL SE CITY tV tKt l I STATE `�/VH ZIP OWNER PHONE:503-560-3109 OWNER EMAIL:ROSATEMPERLY(a7GMAIL.COM CONTRACTOR COMPANY NAME:M FIRE PROTECTION SYSTEM WA STATE CONTRACTOR LICENSE#(REQUIRED):M F I RE F P810 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 3515 N O RTH S H O RE BLVD NE CITY L V t K t I I STATE V"H ZIP 04 Z Z CONTRACTOR PHONE:253-315-9266 CONTRACTOR EMAIL:BYRON.M(a�M F I R E P ROT E CT I C PRIMARY CONTACT: ❑OWNER Z CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-315-9266 BYRON MORALES CONTACT EMAIL:boron.m(a�mfireprotectionsystem.cc FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$7000 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: ZSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: install a new fire sprinkler system in a existing adult family homecare. The system will be a stand alone per NFPA 13D TYPE OF INSTALLATION: ©New Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ZWater Suppression System-#of Heads:ZU ❑Chemical 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMI 2. z,'005— u orize ent Signature Date (Revised 2/8/2021)