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FIR UPPRESSION PERMIT APPLIATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT <br /> SUBMITTAL INSTRUCTIONS;See applicable submittal checklist for submittal requirements and number of copies required for review. <br /> WACRtNoroN 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 5(S :c 7{V?^�r = <br /> i <F•3�` PARCEL#: c"t } '-j J 6 ' , i Cf., <br /> CITY �.t:�,f E f'BrL:,..l.S STA rE t' ZIP (1S--. +k. <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): t (f(Cpci(II644.2.(A:61 ,.(,.r s ' fLt:t( i (, f (.j fl <br /> CONTACT INFORMATION <br /> OWNER NAME: I\Ac%i }L' . `I. 'b a' rl ALL-clic, <br /> OWNER MAILING ADDRESS: STREET 1 CC Z g $> Pir' 1"ts U <br /> cn'r STATE � zia C- 144 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:A L.c- ,4IZ1Ekt L( EW f=:if G_ i U�-t �`"K.JILI (',e+c <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):t.!�t„Ck A ffElAC t- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):( '133 , <br /> CONTRACTOR ADDRESS: STREET rCG,p t i.3 <br /> CITY �+.1I.1.r ;t �•. STATE 1," t`Y-,. ZIP Ci �✓ ,^,* <br /> CONTRACTOR PHONE: '?LI,L -1 '7 f- CONTRACTOR EMAIL: .T; .l dcte t-x{q ;a, {' l: I 1-v1 <br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: .540 -'' <br /> t .t' t� <br /> e�ry k� § CIr,��I.t <br /> CONTACT EMAIL: ,`,dk(asen a c.E l ,,. i , ,21 G:; 4", <br /> FIRE SUPPRESSION PERMIT INFORMATION <br /> VALUATION OF WORK:$ , 74 1' r.. ASSOCIATED PERMIT#(if applicable): 1-_j/i <br /> (Valuation shalt 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: ❑SFR {Townhouse ❑Duplex ❑ADU # )(Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: � . � <br /> ev pLt1.l. 5-7`'+7t-7o,:.i A' 1? gehe ` <br /> " l c, <br /> TYPE OF INSTALLATION: :New Suppression System , Additions/Alterations to existing suppression system DOther-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,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 authonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.tam 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 296.200A WAC. <br /> City of Everett KOfficial Use Only <br /> PERMIT# <br /> OwmAuttic tzecf gent Signature Date (Revised 2/8/2021) <br />