1130 BROADWAY 2024-03-29 - Laserfiche WebLink

FIRE SUPPRESSION PERMIT APPLICATION 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 1 (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1130 BROADWAY, PARCEL#: 00547321801800 CITY EVERETT STATE wa ZIP 98201 SUITE/UNIT#: C FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):TACO BOOK CONTACT INFORMATION OWNER NAME:RIGOBERTO BASTIDA OWNER MAILING ADDRESS: STREET 1130 BROADWAY, UNIT C CITY EVERETT STATE WA ZIP 98201 OWNER PHONE:206-250-2570 OWNER EMAIL:RGBASTIDA@YAHOO.COM CONTRACTOR COMPANY NAME:DINGNOR LLC WA STATE CONTRACTOR LICENSE#(REQUIRED):DINGNL*840N4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 65572 CONTRACTOR ADDRESS: STIEET2701 4TH AVE S CITY SEATTLE STATE ZIP CONTRACTOR PHONE:206-877-2366 CONTRACTOR EMAIL:HENRYDOANB@GMAIL.COM PRIMARY CONTACT: ❑OWNER D CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: H E N RY DOAN CONTACT PHONE:206-877-2366 CONTACT EMAIL:HENRYDOANB@GMAIL.COM FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $2500 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: Installation of Badger Fire Suppression System TYPE OF INSTALLATION: ONew Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: [-]Water Suppression System-#of Heads: ❑Chemical Suppression System-#of Heads: 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:l 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 1 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 6-28-2023 PERMIT# d Owner/Authorized r t Signature Date (Revised 4/21/2022)