910 SE EVERETT MALL WAY PEARLE VISION 2024-06-21

O • 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.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 910 SE Everett Mall Way PARCEL#: 28051800306100 cnv Everett STATE Washington ZIP 98208 SUITE/UNIT#: 103& 104 FLOOR#: NA ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential):Pearle Vision CONTACT INFORMATION OWNER NAME:Pearle Vision OWNER MAILING ADDRESS: sTREET4000 Luxottica Place CITY Mason STATE Ohio ZIP 45040 OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME:AmeriCan Sprinkler Corporation .3a'd 76 WA STATE CONTRACTOR LICENSE#(REQUIRED):AMERISCO87NC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 601 4-4'S1 CONTRACTOR ADDRESS: STREET2311 153rd Ave SE CI,Snohomish STATE Washington ZIP 98290 CONTRACTOR PHONE:425-335-4645 CONTRACTOR EMAIL:doug@americansprink.com PRIMARY CONTACT: ❑OWNER E CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-210-3841 Doug Buehler CONTACT EMAIL:doug@americansprink.com FIRE SUPPRESSION PERMIT INFORMATION VALUATION OF WORK: $4,000 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: ESFR ❑Townhouse ❑Duplex ❑ADU EMulti-Family-#Units: OCommercial ❑Accessory Structure DESCRIPTION OF WORK:Add and relocate fire sprinklers for new walls and ceilings TYPE OF INSTALLATION: ❑New Suppression System ❑✓Additions/Alterations to existing suppression system ❑Other-Describe above TYPE OF SUPPRESSION: I]Water Suppression System-#of Heads:22 ❑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 PERMIT# 00'/::1 f 00( �wnerf uthorized Agent Signature D e (Revised 4/21/2022)