1801 BROADWAY DOMINOS 2025-03-25

FIRE SAPRESSION PERMIT APPLITION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:See applicable submittal checklist for submittal requirements and number of copies required for review, WASHtNOTON 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 (W)everettwa.gov/permits (Blue orBlackinkOnlyP/ease) <PRO,IlECT SITE. INFORMATION PROJECT SiTE ADDRESS: STREET 1801 Broadway Ave PARCEL#: Off, Everett STATE WA ZIP 98201 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Domino's Pizza-Everett OWNER NAME:Everett 18 LLC OWNER MAILING ADDRESS: STREET 1801 Broadway Ave c,ry Everett STATE WA ZIP 98201 OWNER PHONE:360-589-1761 OWNER EMAIL:chris.f@jpcpizza.com CONTRACTOR COMPANY NAME:Performance Systems Integration,LLC WA STATE CONTRACTOR LICENSE#(REQUIRED);PERFOSl8125O CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 61656 CONTRACTOR ADDRESS: STREET 19310 North Creek Pkwy Ste 109 cny Bothell STATE WA ZIP 98011 CONTRACTOR PHONE:206-719-9173 CONTRACTOR EMAIL:stephen.price@psintegrated.com PRIMARY CONTACT: ❑OWNER ✓❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-719-9173 Stephen Price CONTACT EMAIL:stephen,price@psintegrated.com FIRE SUPPRESSION!PERMIT INFORMATION VALUATION OF WORK: $14000 ASSOCIATED PERMIT#(if applicable):E2112 075 (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: New Ansul Hood suppression system for 3-deck XLT Pizza Oven. TYPE OF INSTALLATION: ✓❑New Suppression System ❑Additions/Alterations o existing suppr sion system ❑other-Describe above TYPE OF SUPPRESSIbk V tti,FffiCp)g io SSrstet n-#of Heads:8 hemical S ppression System-#of Heads: NOTE:Application must be submitted with 2 sets of plans,calcs,cut sheets,etc.See submittal checklist everettwa.gov/per Its for further Information. ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein Is f ct.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 properly 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 Only PE M # { /J3/i I Own !Authorized Agent Signature Date (Revised 2/8/2021)