1605 SE EVERETT MALL WAY WALMART 2022-01-14

DocuSign Envelope ID: OD509F87-8274-4DDD-8040-FC12339B260C eERMIT APPLICATIO BUILDINGOECHANICAL / PLUMBING / SIGN / ORINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 1 FAX425-257-8857 l (E) everetteps@everettwa.gov l www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1605 SE EVERETT MALL WAY PROPERTY TAX #: 28051800405600 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Wal-Mart R.E. Bus. Trust - Mary Garduno TENANT BUSINESS NAME (Commercial): Walmart #51 95.239 OWNER MAILING ADDRESS: 2QUESE J Street Bentonville CITY STATE AR ZIP 72716 OWNER PHONE: (479)640-4941 OWNER EMAIL: maricela.garduno@walmart.com CONTRACTOR NAME: Out To Bid CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) AOR Firm CONTACT NAME: Gina Kelly CONTACT PHONE: 918 rj87_8602, ext. 299 CONTACT EMAIL: ginak@sgadesigngroup.com BUILDING INFORMATION Existing Use of Building: Walmart Contract Price of Work: $ 20,000.00 Proposed Use of Building: Walmart Alteration Heat Source: ❑Gas ❑Electric ❑Other existing to remain BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ®Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition LXRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Updating the Sporting Goods area of the Store - adjusting/updating the shelving & counters and adjusting the electrical drops to accommodate updates. ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING' PERMIT APPLICATION Fixture Count List of Fixtures Fixture count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures A/C — Air Handling Units Gas Piping Backflow Preventer (Inside Bldg) Shower, Tub, or Combo Boiler Gas Range Clothes Washer Sink -Commercial (3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink -Residential (kitchen, bath, bar) Duct System (Remodel) lRefrigeration Drinking Fountain Sink -Utility, laundry, mop Exhaust Fans (Residential) Commercial Ventilation (Not Heat/AC system) Floor Drain Toilet Exhaust Hood (Type 1) Hose Bibb Urinal Exhaust Hood (Type 11) Water Heater Interceptor -Grease Waste/Water Piping Repair Exhaust Hood (Residential) Wood Stove Interceptor-Sand/Oil Water Service (behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/InserULog Roof Drains Water Heater SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No. of Heads Chemical Suppression System No. of Heads ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 Building Official before being authorized under any circumstance. / am the owner, or / am authorized by the owner of this property to perform the work for which application is made, and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. DocuSigned by: 9/18/2020 gnature Date City of Everett Official Use Only PERMI ,'/D (Revised 1011012018) /