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FIR2022-0123+Application+11.10.2022_10.36.43_PM+3215275CITY OF EDMONDS nnyst,ilaingPermit.com Fire Application #1228459 - 67943-Edmonds Yacht Club Applicant First Name Last Name Company Name Desiree Forquiqnon Guardian Security Systems Number Street Apartment or Suite Number E-mail Address 1743 1 st Ave S dforquignon(D_quardiansecurity.com City State Zip Phone Number Extension Seattle WA 98134 (206) 678-3846 Contractor Company Name GUARDIAN SECURITY SYSTEMS INC Number Street Apartment or Suite Number 1743 1st ave s City State Zip Phone Number Extension seattle WA 98134 (206) 622-6545 State License Number License Expiration Date UBI # E-mail Address GUARDSS233K5 9/30/2024 600189667 dforquignon(c)_quardiansecurity.com Project Location Number Street Floor Number Suite or Room Number 326 ADMIRAL WAY none none City Zip Code County Parcel Number EDMONDS 98020 27032300401400 Associated Building Permit Number Tenant Name 67943-Edmonds Yacht Club Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name EDMONDS PORT OF Number Street Apartment or Suite Number 300 ADMIRAL WAY 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: 11/10/2022 Submitted By: Desiree Forquignon Page 1 of 2 CITY OF EDMONDS M BuildingPerrnit.com Fire Application #1228459 - 67943-Edmonds Yacht Club Project Contact Company Name: Guardian Security Systems Name: Desiree Forquignon Email: dforquignon@guardiansecurity.com Address: 1743 1 st Ave S Phone #: (206) 678-3846 Seattle WA 98134 Project Type Activity Type Scope of Work Nonresidential Alteration Fire Alarm Project Name: 67943-Edmonds Yacht Club Description of Work: fire alarm system, tenant improvement, adding (20) devices. Project Details Transmitter Type Dual Line Digital Alarm Communicator Fire System Counts Number of Devices 20 Valuation Fair Market Value of Work $6,500 Type of Work Other Panel or Power Supply The work involves a new fire alarm panel or power supply Contact Information Owner Email Address dforquignon@guardiansecurity.com Page 2 of 2