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OLT PERMIT APPLICATION <br /> BUILDING I MECHANICAL / PLUMBING / SIGN I UI RINKLER/ 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 INFORMATIONTI <br /> PROJECT SITE ADDRESS: 12906 By-ethell-Everett HWl"` L- /C PROPERTY TAX#: 280530-004-062-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fred Meyer Stores, Inc. TENANT NAME(If Commercial): Fred Meyer <br /> OWNER MAILING ADDRESS: STREET 3800 SE 22nd Ave c/o Tim Anderson <br /> CITY Portland STATE OR zip 97202 <br /> OWNER PHONE: (503) 797-3885 OWNER EMAIL: tim.anderson@fredmeyer.com <br /> CONTRACTOR NAME L.A\ ►� 1 �,`� u ,JL - =� L�— <br /> CONTRACTOR ADDRESS: STREET ` <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> C <br /> CONTRACTOR LICENSE#(REQUIRED): (t ( ‘0,,,A (j g ITY OF EVERETT BUSINESS LICENSE#(REQUIR D): ,, <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR g OTHER(Please Specify) Engineer/Architect • + ; � <br /> CONTACT NAME: Joel Howitt C/O CONTACT PHONE: (425) 251-6222 <br /> Barghausen Cons. Engrs., Inc. CONTACT EMAIL: jhOWitt@h// rghausen'com <br /> BUILDING PERMIT APPLICATION ( <br /> I <br /> Existing Use of Building: Retail Contract Price of Wor . $ <br /> $150,0001 <br /> F <br /> Proposed Use of Building: Retail Heat Source: ❑Gas L Electric /❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: !Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition 0 Remodel ❑Repair LPT.I. ❑Sign ❑Sprinkler N P-••. (tion ❑Change of Use <br /> DESCRIPTION OF WORK: Construct new minor interior improvement to install new ClickList online grocery shopp r <br /> portal, consisting of new walk-in cooler, new interior partition walls, reach-in freezers, new automatic sliding <br /> exterior door with weather protective awning and minor parking stall re-striping for new pick-up spaces. <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 X Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units 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 Refrigeration Shower 1 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 /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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 /> City of Everett Official Use Only <br /> I I <br /> PERMIT <br /> 0e:Ow - • thorized Agent Signature Date (Revised 9/23/2016) <br />