15 SW EVERETT MALL WAY MASSAGE ENVY 2022-08-11

imm FIRE SSPRESSION PERMIT APPLItATION 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 15 SW Everett Mall Way PARCEL#: 28042400100300 crry Everett STATE WA zip 98204 SUITE/UNIT#: Suites K&L FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Massage Envy CONTACT INFORMATION OWNER NAME:ROSEN BEL-KIRK ASSOCIATES LLC OWNER MAILING ADDRESS: STREET PO BOX 5003 cirr Bellevue STATE WA zip 98009 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:Brimstone Fire Safety Management WA STATE CONTRACTOR LICENSE#(REQUIRED):BRIMSFS918KO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET 20628 Broadway Ave ciry Snohomish STATE WA ZIP 98296 CONTRACTOR PHONE:425-956-3434 CONTRACTOR EMAIL:shelley@brimstonefiresafety.com PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-956-3434 Shelley Friedman CONTACT EMAIL:shelley@brimstonefiresafety.com FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$10,000 ASSOCIATED PERMIT#(if applicable):FA2203 008 (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 ElAccessory Structure DESCRIPTION OF WORK: Tenant Improvement, relocating 25 sprinkler heads and adding 4 sprinkler heads to accomodate new walls. TYPE OF INSTALLATION: ❑New Suppression System EAdditions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑✓Water Suppression System-#of Heads:30 ❑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'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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only xA fni,et�.rna,tt, 4/27/2022 PE 'Z'ZQ11 60 ffV Owner/Authorized Agent Signature Date (Revised 4/21/2022)