FIR2021-0066+Application+7.1.2021_1.59.53_PM+2279969CITY OF EDMONDS
Fire Application #985670 - 59096-Everett Clinic
Applicant
First Name
Last Name
Desiree
Forquiqnon
Number
Street Apartment or Suite Number
1743
1 st Ave S
City
State Zip
Seattle
WA 98134
Contractor
Company Name
GUARDIAN SECURITY SYSTEMS INC
Number
Street
1743
1st ave s
MyBuildingPermit.com
Company Name
Guardian Security Systems
E-mail Address
dforquignon(D_quardiansecurity.com
Phone Number Extension
2066783846
Apartment or Suite Number
City
State Zip
Phone Number Extension
seattle
WA 98134
(206) 622-6545
State License Number
License Expiration Date
UBI # E-mail Address
GUARDSS233K5
9/30/2022
600189667 dforquignon (c)_quardiansecurity. corn
Project Location
Number Street
Floor Number Suite or Room Number
21401 72ND AVE W
NONE NONE
City
Zip Code
County Parcel Number
EDMONDS
98026
00580700002208
Associated Building Permit Number
Tenant Name
59096-Everett Clinic
Additional Information (i.e. equipment location or special instructions).
Work Location
Property Owner
First Name Last Name or Company Name
HSRE EDMONDS MOB OWNER LLC
Number Street Apartment or Suite Number
425 7TH ST NE
City State Zip
CHARLOTTESVILLE VA 22902
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 7/1/2021 Submitted By: Desiree Forquignon
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CITY OF EDMONDS MyBui[di ngPerrnit.com
Fire Application #985670 - 59096-Everett Clinic
Project Contact
Company Name: Guardian Security
Systems
Name: Desiree Forquignon Email: dforquignon@guardiansecurity.com
Address: 1743 1 st Ave S Phone #: 2066783846
Seattle WA 98134
Project Type Activity Type Scope of Work
Nonresidential Alteration Fire Alarm
Project Name: 59096-Everett Clinic
Description of Work: fire alarm system, tenant improvement, adding (2) devcies.
Project Details
Transmitter Type
Digital Alarm Communicator With Cellular Back Up
Fire System Counts
Number of Devices 2
Valuation
Fair Market Value of Work $2,000
Panel or Power Supply
The work does not involve a new fire alarm panel or
power supply
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