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PERMIT APPLICATIOA <br /> 1121 <br /> BUILDINOMECHANICAL/ PLUMBING /SIG PRINKLER/ DEMOLITION <br /> EVERETT CITY 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 SIfTE 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 /> ONTACT_INFORM m� � ,,. <br /> OWNER NAME: Kroger TENANT BUSINESS NAME(Commercial): QFC #852 <br /> OWNER MAILING ADDRESS: STREET 1014 Vine St <br /> CITY Cincinnati STATE OH Zip 45202 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME:Key Mechanical <br /> CONTRACTOR ADDRESS: STREET 19430 68th Ave S <br /> /K� /� CITY Kent <br /> STATE WA Z,P 98032 <br /> f�A.ITI,A/.TAr]nuts. )i'1 _Q79_;/K a/ I ..11 <br /> r _�err+nrnollnli Imonhanical.com VVIII 1%AV I VI\ I IV V I.L..-VV I VV0- VVI\If\AV I VI\GIIIIAIL•IIVVVI VII`I\VJI I <br /> CONTRACTOR LICENSE#(REQUIRED):KEYM EW*240NZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 01 3277 <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-396-3022 <br /> Wayne Cornell CONTACT EMAIL:wcof neII C' keymechanicaI.com <br /> • BUILDING INFORMATION <br /> Existing Use of Building:Groceries Contract Price of Work:$142,358 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition EIRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Replace 35 cases like for like and connect condensate drains to existing floor hubs <br /> ASSO PERMIT#(if applicable): <br /> CIMECHANICA ERMIT,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 /> 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 Ventilation 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 35 Other: Cases Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/InserULog Roof Drains Water Heater <br /> 'SPRINKLER I SUPPRESSION'SYSTEM;' Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <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 1 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 /> PE <br /> ‘1(LOI'Le-40�/0 /7.-�'LU 1 -G <br /> Or/Authorized A ent Signature Date (Revised 10/10/2018) <br /> Z <br />