12906 19TH AVE SE IN N OUT PHO 2023-06-13

FIRE S•PRESSION PERMIT APPLOATION 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 1 (W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 12906 19TH AVE SE, SUITE B PARCEL#: 28053000406200 CITY EVERETT STATE WA ZIP 98208 SUITE/UNIT#: SUITE B FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):IN AND OUT PHO CONTACT INFORMATION OWNER NAME:DAVID LAM OWNER MAILING ADDRESS: STREET 12906 BOTHELL EVERETT HWY CITY EVERETT STATE WA ZIP 98208 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:SMITH FIRE SYSTEMS INC WA STATE CONTRACTOR LICENSE#(REQUIRED):SMITHFS1360T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 23577 CONTRACTOR ADDRESS: STREET 1106 54TH AVE E CITY TACOMA STATE WA zip 98424 CONTRACTOR PHONE:(253) 926-1880 CONTRACTOR EMAIL:TTRAN@SMITHFIRE.COM PRIMARY CONTACT: ❑OWNER •CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:253-248-2044 THUAN TRAN CONTACT EMAIL:TTRAN©SMITHFIRE.COM FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $5,907.00 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and e quipment needed to complete the work,whether ac tually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: *Commercial ❑Accessory Structure DESCRIPTION OF WORK: SMITH FIRE SYSTEMS (SFS) WILL MODIFY THE EXISTING SPRINKLER SYSTEM TO ACCOMMODATE THE NEW WALLS. TYPE OF INSTALLATION: ❑New Suppression System RAdditions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: •Water Suppression System-#of Heads: 10 ❑Chemical Suppression System-#of Heads: 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 nerein 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 I comply with the State Contractors Law 18 27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# 2 K 2 Z 0 `� 0 0 Owner/Authorized Agent Signature Date (Revised 2/8/2021) 11