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FIRE ALARM PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop off application and submittal documents at 3200 Cedar Street 2nd Floor Drop Box <br />WASHINGTON CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 1605 SE Everett Mall Way <br />BUILDING AREA: 91,419 sq ft <br />PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ ADDITION ✓❑ TENANT IMPROVMENT ❑ REMODEL <br />BUILDING USE: ❑ SFR ❑ TOWNHOUSE ❑ DUPLEX ❑ ADU ❑ MULTI -FAMILY - # OF UNITS: [E]COMMERCIAL <br />PERMIT INFORMATION & DESCRIPTION OF WORK <br />CONTRACT PRICE OF WORK: $ 19,723.0o <br />ASSOCIATED ELECTRICAL PERMIT # (REQUIRED): E2308-003 <br />DESCRIBE SCOPE OF WORK: Emergency Responder Radio Coverage System <br />PLAN REVIEW REQUIREMENT <br />Plan review by the Fire Department is required prior to permit issuance. Confirm the required items are included by checking the boxes: <br />Check the boxes below to indicaticate all documents that are being submitted with this permit application: <br />✓❑ 2 Sets of Specifications for the Devices to be installed (Equipment technical data sheets) <br />✓❑ 2 Sets of Plans - Must include the following: <br />0 Location of fire alarm devices <br />s❑ Battery calculations & voltage drop calculations for notification appliance circuits <br />El Sequence of operation in either an input/output matrix or narrative form <br />CONTACT INFORMATION <br />OWNER NAME: Walmart TENANT BUSINESS NAME (If Commercial): Walmart <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: Amplified Wireless Solutions <br />CONTRACTOR ADDRESS: STREET2355 State Street, Suite 101 <br />CITY Salem STATE OR ZIP 97301 <br />CONTRACTOR PHONE:503-686-067o <br />CONTRACTOR EMAIL: imuzynoski@a-w-s-inc.com <br />CONTRACTOR LIC. #(REQUIRED): AMPLIWS832JS <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 58677 <br />PRIMARY CONTACT: ❑ OWNER OCONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Denise Muzynoski <br />CONTACT PHONE:406-451-3036 <br />CONTACT EMAIL: d.muzynoski@a-w-s-inc.com <br />AGREEMENT: l hereby certify that/ have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority <br />to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by <br />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 296.200 <br />WAC. <br />8/1 /2023 <br />'96'iee y%az�nos� <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT #: <br />FA <br />(Revised 412112022) <br />