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grr PERMIT APPLICATION <br /> BUILDING EC-HANICAL-/-PLUMBING SIGNIIr-RINKL-ER-f 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: 5209 Evergreen Way, Everett, WA 98203 PROPERTY TAX#: 28050600100200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Asia First Inc. TENANT NAME(If Commercial): Grocery Outlet <br /> OWNER MAILING ADDRESS: STREET 565 Grocery treet <br /> S <br /> 5650 Hollis Street <br /> cit, Emeryville STATE CA ZIP 94608 <br /> OWNER PHONE: (510) 704-2898 OWNER EMAIL: thaghayegh@cfgo.com <br /> CONTRACTOR NAME: e--F` L�(y1 'SOIcel+,_. 0 -r- (4. ova 11,....,e_> <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)• ► I\L I ?0.-Ptect C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �..C.) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ® OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE: (913) 262-9095 <br /> Teresa Jones, BRR Architecture, Inc. CONTACT EMAIL: teresa. jones@brrarch.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Retail Store Contract Price of Work: $225, 000 <br /> Proposed Use of Building: Retail Store Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: _ ®Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ®Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Construct new Grocery Outlet store in empty tenant space previously utilized as a retail store. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): --7 <br /> MECHANICAL PERMIT APPLICATIJI PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _#of Alteration #of <br /> // #of Repair Type of Project: _New Addn Alteyition _Repair <br /> #of List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures/ Fixtures Fixtures _ <br /> A/C-Air Handling Units / Heat Pump Toilet Ackflow Preventer(Inside Bldg) <br /> Forced Air Systems ,/ Unit Heater Bathtub ./7 Urinal <br /> Gas Piping , / (Bpiler Lavatory(Wash Basin) fwinking Fountain <br /> Water Heater / Refrigeration Shower �.,.r Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal r 0,.se Trap <br /> Gas Range i Ducting Dishwasher /' oof Drains <br /> Clothes Dryer H..kups k Other: Clothes Washer / Medical Gas <br /> Range Hood / Water Heater ,, �t Other: <br /> Exhaust Fay Sink(Service/B Mo. s Other: <br /> �% <br /> / <br /> SPRIN$tER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKN•WLEDGEA4, NT: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 /> curren federal,sta \and local la . The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buildi : Offi ial before being auth.'rized 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 Ally, it the tate Co `a, ors Law 18.27 RCW and 296.200A WAC. <br /> �1 �� City of Everett Official Use Only <br /> ''` \\` ` PERMIT#n 1-�-0t4E <br /> Own• /A o,edArQ,,t I•nature Date (Revised 9/23/2016) "I <br />