2615 BROADWAY QFC 2021-11-10 - Laserfiche WebLink

FIRE SUtPRESSION PERMIT APPLIATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASH INGTON 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 (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2615 BROADWAY STREET PARCEL#: crry EVERETT STATE WA zIP 98201 SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):QFC GROCERY STORE#853 CONTACT INFORMATION OWNER NAME:QFC GROCERY OWNER MAILING ADDRESS: sTREET2615 BROADWAY STREET Tiny EVERETT STATE WA zip 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:SANDERSON FIRE PROTECTION WA STATE CONTRACTOR LICENSE#(REQUIRED):SANDEFP845DN .,i; CITY OF EVERETT BUSINESS LICENSE#(REQUIR ):(0t 2A e CONTRACTOR ADDRESS: STREET 774 INDUSTRY DRIVE cm, TUKWILA STATE WA ZIP 98188 CONTRACTOR PHONE:503-889-3110 CONTRACTOR EMAIL:GEOFF@SANDERSONFIRE.COM PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: G E O F F S PA H R CONTACT PHONE:503-889-3110 CONTACT EMAIL:GEOFF@SANDERSONFIRE.COM FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $1200.00 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: INSTALL/HOOKUP OF PREPIPED ANSUL R-102 UL300 KITCHEN FIRE SUPPRESSION SYSTEM INTO TYPE ONE EXHAUST HOOD TYPE OF INSTALLATION: ❑✓New Suppression System ❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑Water Suppression System-#of Heads. ✓❑Chemical Suppression System-#of Heads:8 NOZZLES NOTE:Application must be submitted with 2 sets of plans,talcs,cut sheets,etc.See submittal checklist at everettwa.gov/permits for further information. 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 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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use*lily PER I #f2t . i U Qg n [J�I� �/t✓. �G�c� 09/05/2021 Owner/Authorized gent Signature Date (Revise 2/8/2021)