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PERMIT APPLICATIO i <br /> BUILDIN. I iJIECHANICAL/ PLUMBING / SIGRINKLER/ DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (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:4919 Evergreen Way PROPERTY TAX#:0260935 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Claremont Village Station LLC/Bintou Bayo,QFC Inc. TENANT BUSINESS NAME(Commercial): Quality Food Centers, Inc. <br /> OWNER MAILING ADDRESS: STREET3701 S Norfolk Street, Suite 301 <br /> cin. Seattle STATE WA zip 98118 <br /> OWNER PHONE: (316)303-7312 OWNER EMAIL:bintou.bayo@qfci.com <br /> CONTRACTOR NAME:Keith Paredez,Green Way Construction,LLC <br /> CONTRACTOR ADDRESS: STREET 21195 NE Evergreen Parkway#205 <br /> CITY Hillsboro STATE OR ZIP 97124 <br /> CONTRACTOR PHONE:(503)726-1922 CONTRACTOR EMAIL:keithp@greenway-Ilc.com <br /> CONTRACTOR LICENSE#(REQUIRED):GREENWC939RO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 56248 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR CI OTHER(Please Specify) Architect/Owner's Agent <br /> CONTACT NAME: CONTACT PHONE:(971)346-3665 <br /> Kitty Yunger CONTACT EMAIL:kyunger@a mcknze.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Grocery Contract Price of Work: $ USD 1 C'VU <br /> Proposed Use of Building:Grocery Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ZCommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑✓Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Remodel of existing QFC store to include removal of VCT flooring, , new <br /> —Da yr cooler, memrtt2Csr, newrefric e ratedV cases, and new low wall at Floral prep. <br /> c <br /> ASSOCIATED BUILDING PERMIT#(if applicable): a'C.N>0 :C'_ <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 4 <br /> NC—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 Ventilatior _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: Medica)Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Ropf`Drains Water Heater <br /> SPRINKLER/ SUPPRESSION SYSTEM ,y:Sewage Ejector or Sump Pump Other: <br /> s <br /> Water Suppression System No.of Heads I <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 /> City of Everett Official Use Only <br /> Or <br /> 7-/v P � o -ate <br /> Owner/ uthonzed Agent "gnatu //1/�r/li� aTS#Date (Revised 10/10/2018) <br /> /7_ <br />