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grr PERMIT APPLICATION I <br /> BUILDINAECHANICAL / PLUMBING / SIGNIMPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps©everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:6727 Evergreen Way PROPERTY TAX#:00392900500800 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Albertson's Stores Sub LLC TENANT BUSINESS NAME(Commercial): Big Lots <br /> OWNER MAILING ADDRESS: sTREET250 Parkcenter Blvd. <br /> CITY Boise STATE ID ZIP 83706 <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAM;:T . L. IN cj���N"-- Qs,N ezs -. <br /> CONTRACTOR ADDR' - • STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): •`'v � \`� Lp—CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): l Q <br /> l <br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify) Expediter r---_____ <br /> CONTACT NAME: 'CONTACT PH E:949.582.3735 <br /> Mary Ryan CONTACT MAIL:mary@permitresources.com <br /> BUILDING IN RMATION <br /> Existing Use of Building:M Contract Price of Work: 55 `-{(,mo i <br /> Proposed Use of Building:M Heat Source: ❑Gas ❑Electric ❑Other ,Q,k,. 1---- <br /> BUILDING <br /> /BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: TI - Remodel of(E) space including doors, partitions, ceilings, fixtures, etc. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture List of Fixtures Fixture I Listxtures Fixture List of Fixtures Fixture y"List of Fixtures <br /> Count Count ��. Count Count �f <br /> A/C—Air Handling Units Gas'Piping Backflow Preventer(Inside Bldg) ,, flower,Tub,or Combo <br /> Boiler ,'as Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer / Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) /,� Refrigeration Drinking Fountain y Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain ,� Toilet <br /> Exhaust Hood(Type I) / ,(Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II;' Water Heater Interceptor-Greg Waste/Water Piping Repair <br /> Exhaust Hood(Res' ential) Wood Stove Interceptor- d/Oil Water Service(behind meter) <br /> Forced Air Syste s _Other: Medical s Water Valves or Fixtures <br /> Gas Fireplace/ sert/Log Roof ins Water Heater <br /> SPRINK(L / SUPPRESSION SYSTEM Se age Ejector or Sump Pump Other: <br /> Water Suppression stem No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ers <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the 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 /> PERM <br /> K-#t. , r'S. 1/9/19 t)�a l0 I - 02_3 <br /> OwrferlAuthorized Ag rz4ignature Date (Revised 10/10/2018) ; j/ <br /> 1Z_ <br />