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FIRE SUPPRESSION PERMIT APPLiCly EOVE <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirem and �^�rflAfQop, quired eview, <br /> wASHINGTON then drop off completed application plus all required submittal documents to Ced7F refit A Fed Intake p Box. <br /> CONTACT INFORMATION: (P)425-257-8810 1(E) PermitServices@everettwa.gov 1 everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION' = <br /> PT <br /> PROJECT SITE ADDRESS: STREET 3003 WEST CASINO ROAD PARCEL#: 280410o0100200 <br /> CITY EVERETT STATE WA zla 9820 <br /> SUITEIUNIT#: �' FLOOR M ADDITIONAL LOCATION INFORMATION: BUILDING 40-03 <br /> TENANTIBUSINESS NAME(if non-residential):BOEING <br /> CONTACT INFORMATION <br /> OWNER NAME:BOEIN.G-EVERETT FACILITY <br /> OWNER MAILING ADDRESS: ITREET3003 WEST CASINO ROAD <br /> CITv EVERETT STATE WA zip 98203 <br /> OWNER PHONE:425-330-1807 OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME:FIRE SYSTEMS WEST <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):FIRESWI140B1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 022919 <br /> CONTRACTOR ADDRESS: ITIEET206 FRONTAGE ROAD N, SUITE C <br /> CIT. PACIFIC STATE WA ZIP 98047 <br /> CONTRACTOR PHONE:253-833-1248 CONTRACTOR EMAIL:WAYNEB@FIRESYSTEMSWEST.COM <br /> PRIMARY CONTACT: ❑OWNER Z CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:253-507-6041 <br /> WAYN E B E L L I N CONTACT EMAIL:WAYNEB@FIRESYSTEMSWEST.COM <br /> 'FIRE SUPPRESSION PERMIT INFORMATION. <br /> VALUATION OF WORK:$23180 ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevailing fair market value of all labor,matenals,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: (]Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> RELOCATION OF RACK SYSTEM, INCLUDING REPLACEMENT OF 17 SPRINKLER <br /> HEADS. <br /> TYPE OF INSTALLATION: ❑New Suppression System CAdditions/Alterations to existing suppression system ❑Other-Describe above <br /> TYPE OF SUPPRESSION: ✓❑Water Suppression System-#of Heads: 17 []Chemical Suppression System-#of Heads: <br /> NOTE:Application must be submitted with 2 sets of plans,calcs,cut sheets,etc.See submittal checklist at everettwa.gov/permits for further information. <br /> 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 <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.orl amauthorized 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 Official Use Only <br /> DigitallWAYN E B E LL I N BELLIfV signed by WAYNE PERMIT# 2 <br /> Date:2023.09.0715:04:15-07'00' K o J O q a! <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />