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FIRE SUIORESSION PERMIT APPLI•TION <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 /> 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.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREETS Th S i7 PARCEL# -il,g 5 -ir") <br /> CITY Cu e,reit j IAA <br /> %� 9O? STATE ZIP <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):` 0 `\ <br /> CONTACT INFORMATION <br /> OWNER NAME: 0,0Ue 00 hh MOJC1,0e , LL.0 <br /> OWNER MAILING ADDRESS: STREET (D PlU t, \�,�A`, 690 <br /> CITY 15 �ve, f , C ^) a �.1 STATE ZIP <br /> OWNER PHONE: 1-125—bRO 61 O OWNER EMAIL: et\ ro ''CC <br /> r <br /> CONTRACTOR COMPANY NAME: th( ' j ,n ., <br /> t` <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):kektE,1*2AIR_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ' a <br /> CONTRACTOR ADDRESS: STREETI65 200Th (i <br /> CITY Ke A-1 W* S 3 g, STATE ZIP <br /> CONTRACTOR PHONE:(c j )137 CONTRACTOR EMAIL: MeU(\®Qcr VSTcx -jC1 .cram <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(OW)b`l -1d62 <br /> k\e lVeiben CONTACT EMAIL:mev: k wthei ec rfacodim c:O(Y <br /> FIRE SUPPRESSION PERMIT INFORMATION <br /> VALUATION OF WORK:$ a, 01 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 paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Kcommercial ❑Accessory Structure <br /> DESCRIPTION OF WORK:NA Wi,.ca EcksrecN\ti SccV\V-Icef <br /> wo30\. ks)c h6n5. 1 "elcx.,o�,vc. 4 {NtacK,- '� <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: 5 ❑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 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 l am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# � n � I© r �O <br /> � P io/ii/off 1 L <br /> Owne ut orized Agen Signat • Date (Revised 2/8/2021) t/ <br /> Z <br />