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OSIETT— PERMIT APPLICATION. <br /> BUILDING ; MECHANICAL / PLUMBING / SIGNIMPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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: 10200 19th Ave SE PROPERTY TAX#: 0270124 <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Costco TENANT BUSINESS NAME(Commercial): Costco <br /> OWNER MAILING ADDRESS: STREET 10200 19th Ave SE <br /> CITY Everett STATE WA z,P 98208 <br /> OWNER PHONE:425-330-9879 OWNER EMAIL:W114adm@costco.com <br /> CONTRACTOR NAME:Fire Systems West <br /> CONTRACTOR ADDRESS: STREET 206 Frontage Road N, Suite C <br /> c,T, Pacific STATE WA Z,,, 98047 <br /> CONTRACTOR PHONE: 2553-833-1248 CONTRACTOR EMAIL: jlmt@flresyStemSWeSt.Com <br /> CONTRACTOR LICENSE#(REQUIRED): FIRESWI140B1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 02291 9 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 253-202-7019 <br /> Jim Turk CONTACT EMAIL: jimt@firesystemswest.com <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work: $ t /2-1t6 .('-‘% <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑✓Repair ❑T.l. ❑Sign ❑`'Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Per NFPA 25 sprinklers that are damaged, corroded or loaded need to be replaced. <br /> Will be replacing (24) sprinkler heads in the bakery area. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C–Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas 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 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-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtjres <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System 114_ No.of Heads <br /> Chemical Suppression System 'No.of Heads <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 /> ,-- <br /> City of Everett Official Use Only <br /> I PERMIT <br /> — --, 1/ I .7 / I I' <br /> Owner/A}tithorized Agent Signature /Date (Revised 10/10/2018) ✓ <br /> i <br />