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PERMIT APPLICATIO <br /> / ��� BUILDING MECHANICAL/ PLUMBING /SIGN RINKLER/ DEMOLITION <br /> A►� CITY OF EVERETT PERMIT SERVIC. <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black=Ink Only Please) PROJECT SITE INFORMATION, <br /> PROJECT SITE ADDRESS: 405 SE EVERETT MALL WAY PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Target# 337 TENANT NAME(If Commercial): Target # 337 <br /> OWNER MAILING ADDRESS: STREET PO BOX 9456 <br /> cITY MINNEAPOhIS., STATE MN ZIP 55440 <br /> OWNER PHONE: (OWNER EMAIL: <br /> CONTRACTOR NAME: Source Refrigeration & HVAC, Inc. <br /> CONTRACTOR ADDRESS: STREET 145 S. State College Blvd. Ste# 200 <br /> cITY Brea STATE CA ZIP 92821 <br /> CONTRACTOR PHONE: 503-327-3266 CONTRACTOR EMAIL: rhorton(sourcerefrigeration.corn <br /> CONTRACTOR LICENSE#(REQUIRED): SOURCRI995PE CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 39891 <br /> PRIMARY CONTACT: 0 OWNER 14 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 503_327_3266 <br /> Rebecca Horton CONTACT EMAIL: rhorton@sourcerefrigeration.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Grocery Store Contract Price of Work:$ 24,134.00 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric Ether Re�t;g,A.�,al,, <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 6Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair T.I.W ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Demo 4 existing cases, install 5 owner furnished cases. install piping & valves per RS <br /> Convert existing sysA02 to dual temp, relocate alarm panel per dwg,Terminate EMS sensor wiring.revise <br /> temps on sys's B01,B02,B04. Condensate to drain to ex floor sinks or drains. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): B1802-006 <br /> MECHANICAL PERMIT APPLICATION: PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn X Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures <br /> I A/C—Air Handling Units Heat Pump r_____.Toilet Backflow Preventer(Inside Bldg) <br /> r Forced Air Systems - <br /> Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 5 Refrigeration _ Shower Floor Drain <br /> Gas Fireplace _ Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range - Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups - Other: ! Clothes Washer Medical Gas <br /> Range Hood r Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this p ;cation n c firm t e information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> LrC'i ex...,e,cc...4...a. ojii <br /> $! �-- i X PERMITM ( 00--o34( 00'®34 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) l I <br /> Z <br />