12906 19TH AVE SE JOINT CHIROPRACTIC 2023-02-06

• 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 I(E)PermitServices@everettwa.gov I(W)everettwa.govlpermits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 12906 BOTHELL-EVERETT HWY-SUITE C PARCEL#: 28053000406200 cm, Everett STATE WA ZIP 98208 SUITE/UNIT#: C FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):JOINT CHIROPRACTIC CONTACT INFORMATION OWNER NAME:FRED MEYER STORES INC OWNER MAILING ADDRESS: STREET 1014 VINE ST FL 7 crry CINCINNATI STATE OH zip 45202 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:CROWN FIRE PROTECTION, INC WA STATE CONTRACTOR LICENSE#(REQUIRED):CROWNFP044LL CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 031397 CONTRACTOR ADDRESS: STREET PO BOX 12113 cmr MILL CREEK STATE WA zip 98082 CONTRACTOR PHONE:4254817669 CONTRACTOR EMAIL:CRISTIE@CROWNFP.COM PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4254817669 CRISTIE OG LAND CONTACT EMAIL:CRISTIE@CROWNFP.COM FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK:$900 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:ADD 2 SPRINKLER HEADS AND RELOCATE 1 FOR A TENANT IMPROVEMENT • TYPE OF INSTALLATION: ❑New Suppression System ✓❑Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: ❑✓Water Suppression System-#of Heads:3 ❑Chemical Suppression System-#of Heads: NOTE:Application must be submitted with 2 sets of plans,caics,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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everettre� �_i Official Use Only I PERMIT# ),Z04 Owner/Aut rized Agent Signature Date (Revised 4/21/2022) yz_