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FIRE S•PRESSION PERMIT APPSCATION
<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) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: STREET 9'72O .7� r/. f�/� .Lo/,� PARCEL#:
<br /> CITY Ei/�e.� STATE L/j� ZIP yB�U&
<br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: 207- 2,
<br /> TENANT/BUSINESS NAME(if non-residential):
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,L e__ 1kI 4 / roc- CC::.•ti "...'" 1
<br /> OWNER MAILING ADDRESS: STREET 5:2 ‘, N . Q;T 14't/ _3, �'.e I` • - ,
<br /> CITY 4/2 j , ,,,G',, ,- / STATE LA pa. ZIP 2 Q 2'z3
<br /> OWNER PHONE: 3(..(:) 6, / -- Z Z OWNER EMAIL:
<br /> CONTRACTOR COMPANY NAME: ,,(3 i—(1C A F2 U I--)yz TpcT(o-1
<br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): s„u / . 9,,,,e CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6 e., 5 /
<br /> CONTRACTOR ADDRESS: STREET //`? /(/,q,r(/Q 7-- wi,4 . /2
<br /> CITY s[ 7 ‹ 4 �] # STATE 144 e. ZIP 9,7 F_
<br /> CONTRACTOR PHONE: 2ee6---972— /.zs- CONTRACTOR EMAIL: .5-'E ,2.4: Plez),—tcT'q,J e 4,,,,a, , (--t;;.,..-,
<br /> ,,
<br /> PRIMARY CONTACT:r )WNER [ONTRACTOR CJTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> /Wigs4k SI-841e_...4.S' CONTACT EMAIL: mT5 7— ✓4.7,/ - ,_2 e yam?,/,,, •coi ,
<br /> FIRE SUPPRESSION PERMIT INFORMATION
<br /> VALUATION OF WORK: $ VIt pp U ASSOCIATED PERMIT#(if applicable): it;) �/0 c -- Qe-r 6
<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: 'FR [-Townhouse r---)uplex {—,DU Multi-Family-#Units: flommercial r--,ccessory Structure
<br /> DESCRIPTION OFWORK:
<br /> s62_ (::::v-t-vv, i 1..... . Woetw...__
<br /> AJF ►Frc 13 D
<br /> TYPE OF INSTALLATION:, . lew Suppression System rdditions/Alterations to existing suppression system )they-Describe above
<br /> TYPE OF SUPPRESSION: Vater Suppression System-#of Heads: :hemical Suppression System-#of Heads:
<br /> NOTE:Application must be submitted with 2 sets of plans,talcs,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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Offirdal Use Only
<br /> L- Z11-,7-) _______=--'
<br /> PERMIT# V t I Oc �005
<br /> Owneruthor zed Agent Signature ate (Revised 2/8/2021)
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