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FIR2021-0123+Application+11.9.2021_3.43.09_PM+2511713CITY OF EDMONDS Fire Application #1047499 - Lifestance TI Applicant First Name Last Name Kathi O'Rear MyBuildingPermit.com Company Name Northwest Fire Systems LLC Number Street Apartment or Suite Number E-mail Address 22645 83rd Ave S Bldq D City State Zip Kent WA 98032 Contractor Company Name Northwest Fire Systems LLC Number Street 22645 83rd Ave S Bldq D City State Zip Kent WA 98032 State License Number License Expiration Date UBI # NORTHFS928CR 2/20/2022 602799167 Project Location Number Street 21727 76TH AVE W korear(cD_nwfiresystems.com Phone Number Extension (206) 772-7502 Apartment or Suite Number Phone Number Extension (206) 772-7502 E-mail Address korear(a)_nwfiresystems.com City Zip Code County Parcel Number EDMONDS 98026 00580700002701 Associated Building Permit Number Tenant Name Lifestance Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Number Street PO BOX 92129 Last Name or Company Name HR ACQUISITION I CORPORATION Floor Number Suite or Room Number 1 C & D Apartment or Suite Number City State Zip SOUTH LAKE TX 76092 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: 11/9/2021 Submitted By: Kathi O'Rear Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Fire Application #1047499 - Lifestance TI Project Contact Company Name: Northwest Fire Systems LLC Name: Kathi O'Rear Email: korear@nwfiresystems.com Address: 22645 83rd Ave S Bldg D Phone #: (206) 772-7502 Kent WA 98032 Project Type Nonresidential Activity Type Alteration Scope of Work Fire Sprinkler Systems Project Name: Lifestance TI Description of Work: Fire Sprinkler TI; providing proper sprinkler coverage for new ceiling and wall layout. 40 sprinkler heads. No change to hydraulic calculations. Project Details Fire System Type NFPA 13 Fire System Counts Number of Heads Added 40 Valuation Fair Market Value of Work $10,110 Page 2 of 2