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FIR2021-0065+Application+6.26.2021_1.21.04_PM+2271219CITY OF EDMONDS Fire Application #983333 - Thrive Kids Dentistry Applicant First Name Last Name Company Name JERRY MOFFETT Ace Fire Systems LLC Number Street Apartment or Suite Number E-mail Address PO Box 2065 acefiresystems(D_comcast.net City State Zip Phone Number Extension Buckley WA 98321 2062768872 Contractor Company Name Ace Fire System LLC Number Street P.O. box 2065 MyBuildingPermit.com City Buckley State License Number ACEFIFS908M3 Project Location Apartment or Suite Number State Zip Phone Number Extension WA 98321 (206) 349-1175 License Expiration Date UBI # E-mail Address 7/23/2022 603032125 acefiresystems(a-comcast.net Number Street 10032 EDMONDS WAY City Zip Code EDMONDS 98020 Associated Building Permit Number Additional Information (i.e. equipment location or special instructions). Work Location Property Owner County Parcel Number 00610700200600 Tenant Name Thrive Kids Dentistry Floor Number Suite or Room Number 1 retail 2 First Name Last Name or Company Name The Village at Westgate LLC The village at Westgate LLC Number Street Apartment or Suite Number 10032 EDMONDS WAY retail 2 City State Zip EDMONDS WA 98020 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: 6/26/2021 Submitted By: JERRY MOFFETT Page 1 of 2 i CITY OF EDMONDS MyBui[di ngPerrnit.com Fire Application #983333 - Thrive Kids Dentistry Project Contact Company Name: Ace Fire Systems LLC Name: JERRY MOFFETT Email: acefiresystems@comcast.net Address: PO Box 2065 Phone #: 2062768872 Buckley WA 98321 Project Type Activity Type Scope of Work Nonresidential Alteration Fire Sprinkler Systems Project Name: Thrive Kids Dentistry Description of Work: Convert existing upright heads to pendents at new TI ceilings Project Details Fire System Type NFPA 13 Fire System Counts Number of Heads Added 32 Valuation Fair Market Value of Work $8,700 Page 2 of 2