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El <br />PERMIT APPLICATIO <br />BUILDINAECHANICAL / PLUMBING / SIGN 'PRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 10200 19th Ave SE <br />PROPERTY TAX #: 28051900101000 <br />LEGAL for new construction: Short Plat/subdivision N.A. Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Costco Wholesale Corporation TENANT NAME (If Commercial): Costco Wholesale <br />OWNER MAILING ADDRESS: STREET 999 Lake Dr <br />CITY Issaquah STATE WA ZIP 98027 <br />OWNER PHONE: 425-416-5703 <br />OWNER EMAIL: bscougale@costco.com <br />CONTRACTOR NAME, 75� <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): SC �2— <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 50 t <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR V OTHER (Please Specify) Architect <br />CONTACT NAME: <br />Jim Brennan <br />CONTACT PHONE: 208-577-5648 <br />CONTACT EMAIL: jamesbrennan@ctagroup.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Group M, Mercantile <br />Contract Price of Work $ ! 2 <br />Proposed Use of Building: Group M Mercantile <br />Heat Source: OGas ❑Efectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: Commercial [Industrial <br />Type of Project: ❑New ❑Addition [ORemodel []Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: <br />Renovaterfresh meat and deli departments. Add exterior refrigeration room. <br />ASSOCIATEDBUILDING PERMIT # (if applicable): B1901-007 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New Addn _Alteration <br />_Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Water <br />lChernicai or Water <br />1 104 <br />INo. 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 />Q� PERMIT # <br />04/09/2019 <br />Owner u orized Agent Signature Date (Revised 912312016) I/� <br />