11400 EVERGREEN WAY 2021-11-03 - Laserfiche WebLink

DocuSign Envelope ID:OD509F87-8274-4DDD-8040-FC12339B260C rERMIT APPLICATION BUILDING filECHANICAL / PLUMBING / SIGN / RINKLER / DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 1 1400 Low i-994' E%JE4' ,`Cs LA IA PROPERTY TAX#: 00442900301402 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFOR16ATION OWNER NAME: Wal-Mart R.E. Bus. Trust- Mary Garduno TENANT BUSINESS NAME(Commercial): Walmart #5195.239 OWNER MAILING ADDRESS: 2egaESE 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 0 CONTRACTOR L OTHER(Please Specify) AOR Firm CONTACT NAME: CONTACT PHONE: (918)587-8602, ext. 299 Gina Kelly 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: OGas ❑Electric DOther existing to remain BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: NCommercial ❑Accessory Structure Type of Project: New ❑Addition atRemodel 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 Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures 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) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) 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/ SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads 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 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only litzwSigned by:AVLU O 9/18/2020 PERK#^ 0:A 1 Qtalef04-3pfr4eisbAgent Signature Date (Revised 10/10/2018) 1 2