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E FIRE SL 'RESSION PERMIT APPLIATION <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 I(W)everettwa.gov/permits <br /> (Blue or'Black Ink Only Please) �PROJE/CT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET e.jej `G./ 7L 4 7 \04/U6 PARCEL#: p t12.3S~ <br /> CITY &,e3R-e477- <br /> STATE 41„9,9 ZIP 9:6 <br /> SUITE/UNIT#: FLOOR#11 M 7W ,-//iMIONAL LOCATION INFORMATION: 'V <br /> TENANT/BUSINESS NAME(if non-residential): <br /> �'O CONTACT INFORMATION� h � <br /> OWNER NAME: /4'�'_ V 41-0? i7i)/ Ti /- / S4\ V <br /> OWNER MAILING ADDRESS: STREET /W Sg CDOI SeY �J//� <br /> CITY `�L_-0711 STATE - ✓� ZIP <PM? <br /> OWNER PHONE:c2NS3.16 -V —,69,3yoz OWNER EMAI s&all <br /> CONTRACTOR COMPANY NAME: •' j0 )7� \S510-11 :,2/iPGJ 4 51 0 <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED) f/ ` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ^/Cj' <br /> CONTRACTOR ADDRESS: STREET / ' ($c ck 9 6 el I <br /> CITY / / STATE 41.2i9. ZIP f {,/ l <br /> CONTRACTOR PHONE 5 R 9tL-- CONTRACTOR EMAI / /4 ,•Lea t <br /> PRIMARY CONTACT: OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME• �jy�`� CONTACT PHONE o,2 1 CLV ---949 , ,/ <br /> 4 L SiV 05 /' " CONTACT EMAI : Ata ! 4J� �fY a5% j <br /> FIRE SUPPRESSION PERMI INFORMATION" <br /> VALUATION OF WORK:$ 9/ RV . `�jy" 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 pal or not.) <br /> BUILDING TYPE: LISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> DESCRIPTION OF WO/RK: • <br /> a ,r("dital/f/(zt <br /> :1061Q,IPAAt6-1/ <br /> 9---6 az_cg a ,a-e-eiL M C s--94-4-frpo <br /> /v7w. 9‘, ..... /7-,9 Ipte,' . .1Dot <br /> in adtag4---Z <br /> TYPE OF INSTALLATION: ❑New Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above <br /> TYPE OF SUPPRESSION: ❑Water Suppression System-#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.lam the owner,or lam 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> CNam-/—OW PERMIT# I� Z° ^o 4_3 <br /> Owner/Authorized Ag ign ture Date (Revised 2/8/2021) <br /> Z <br />