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N. In FIRE SilipPRESSION PERMIT APP•ATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist 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 (BlueorBlack Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET LI%�,�ic �j - PARCEL#: /9/9 CITY c. STATE GN/! ZIP 94 20 SUITE/UNIT#: FLOOR#: f.4 . ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): -/:a2 T7—' (J/ CONTACT INFORMATI N � fk L 3 j OWNER NAME: � � 74/V Sefiet 1 ( t1L 1/13/ 7J OWNER MAILING ADDRESS: STREET /46LcS0o2D° ^' �Q CITY f(��1// STATE 'I'� /yV ZIP 9 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: 7 -70 ,"&(/�G��€ /1— SieFo C' . 64 390 WA STATE CONTRACTOR LICENSE#(REQUIRED): IF� ICRHCITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 09 CONTRACTOR ADDRESS: STREET / 'c 2 D Slr OZD D 67: CITY Av / STATE Cel6) ZIP OPee./ CONTRACTOR PHONE: , �pOZ- CONTRACTOR EMAIL: �6 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify)CONTACT NAME: - . CONTACT PHONE: /y�4f J 9ice , A-LETZ c v; ,�'/�. CONTACT EMAIL' " /`2'6 riodaj, FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$ O ^ 910 . 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: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family #Units: Commercial ❑Accessory Structure DESCRIPTION OF WORK: //Ai ` !! ,G 14d Q/, 74, (.z &Ai *1-—/Z W16/721al 'Y-711614(1' At496A P6 _ 77 TYPE OF INSTALLATION: IgGNew Suppression System ❑Additions/Alterations to existing suppression system hdOther-Describe above TYPE OF SUPPRESSION: ❑Water Suppression System-#of Heads: ❑Chemical Suppression System-#of Heads:6��zea- 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-1 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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only N ��7/c^��,�� PERMIT# K 2-7-03 - 004- 0 r1A ized Agent Signature Date (Revised 2/8/2021) I.