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FIR2023-0019+Application+3.8.2023_2.50.28_PM+3409657CITY OF EDMONDS M BuildingPermit.com Fire Application #1279345 - 70021-2 Aldercrest Health & Rehabilitation Applicant First Name Last Name Company Name Krystal Ebner Guardian Security Systems Number Street Apartment or Suite Number E-mail Address 1743 1 st Avenue S kebner(�D_quardiansecurity.com City State Zip Phone Number Extension Seattle WA 98134 (206) 622-6545 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 kebner(a)_quardiansecurity.com Project Location Number Street Floor Number Suite or Room Number 21400 72ND AVE W FACP FACP City Zip Code County Parcel Number EDMONDS 98026 00580700002301 Associated Building Permit Number Tenant Name Aldercrest Health Rehabilitation Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name 21400 72ND LLC Number Street Apartment or Suite Number PO BOX 580 City State Zip LAKEWOOD NJ 08701 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: 3/8/2023 Submitted By: Krystal Ebner Page 1 of 2 CITY OF EDMONDS M BuildingPerrnit.com Fire Application #1279345 - 70021-2 Aldercrest Health & Rehabilitation Project Contact Company Name: Guardian Security Systems Name: Krystal Ebner Email: kebner@guardiansecurity.com Address: 1743 1 st Avenue S Phone #: (206) 622-6545 Seattle WA 98134 Project Type Activity Type Scope of Work Nonresidential Alteration Fire Alarm Project Name: 70021-2 Aldercrest Health & Rehabilitation Description of Work: Installation of AES radio to existing FACP Project Details Transmitter Type Dual Line Digital Alarm Communicator Fire System Counts Number of Devices 1 Valuation Fair Market Value of Work $750 Type of Work Other Panel or Power Supply The work does not involve a new fire alarm panel or power supply Contact Information Owner Email Address kebner@guardiansecurity.com Page 2 of 2