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4TIETT PERMIT APPLICATION <br /> 9UILDI#G ECHANICAL/ Pt-UMBING-I-SIGN-y-RINKLER+E}EMOLITION <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 556655 GHocery Street <br /> 0 Hollis Street <br /> crr Emeryville STATE CA ZIP 99608 <br /> OWNER PHONE: (510) 704-2898 OWNER EMAIL: thaghayegh@cfgo.com <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <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: $ 150,000 <br /> Proposed Use of Building: Retail Store Heat Source: ®Gas 0 Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair OT.l. OSign ❑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): <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> 1 A/C-Air Handling Units 3 Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 27 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 Water Heater Other: <br /> 3 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMEN •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 f-l.eral,state, :n. 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 befor:b:ing 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 /> nd I cyte'o1 tgi(h t j�e 1Sta e C. actors Law 18.27 RCW and 296.200A WAC. <br /> 1'ii:, City of Everett Official Use Only <br /> kviii <br /> tik \ ,q, i _\1 PERM <br /> Owner/Authorized Ag� - • . ure Date (Revised 9/23/2016) --- <br />