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M-amm <br />PERMIT APPLICATION <br />BUILDINGOECHANICAL / PLUMBING / SIGN 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 NA <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: Costco Wholesale Corporation <br />TENANT NAME (If Commercial): CoStCO Wholesale <br />OWNER MAILING ADDRESS: STREET 999 Lake Dr <br />CITY Issaquah <br />STATE WA ZIP 98027 <br />OWNER PHONE: 425-416-5703 IOWNFP EMAIL: bscougale@costco.com <br />CONTRACTOR NAME. �� 1 (-�'�' "`' ` • ��` <br />CONTRACTOR ADDRESS: STREETS <br />CITY <br />STATE ZIP <br />CONTRACTOR PHONE: al� ZS ta 3iq LACA. <br />CONTRACTOR LICENSE #(REQUIREL � — <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />CONTRACTOR EMAIL: <br />I t _ -6, _ VERETT BUSINESS LICENSE #(REQUIR(D): <br />V OTHER (Please Specify) Architect <br />CONTACT NAME;-` ��--,,���� <br />Lim n k3v�; if t. S <br />CONTACT PHONE: �fl�fi-F� Q$� G�9 O <br />CONTACT EMAIL: jamesbrennan@ctagroup.com <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Group M, Mercantile <br />Contract Price of Work: $ T.B.D. <br />Proposed Use of Building: Group M Mercantile <br />Heat Source: 0GaS ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi -Family-# of Units: 1 Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition [ORemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />Renovate fresh meat and deli <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />departments. Add exterior refrigeration room. <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration <br />_Repair <br />Type of Project: _New _Addn <br />_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 />1Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />No. of Heads <br />ACKNOWLEDGEMENT l 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. 1 am the owner, or l 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 />�— 12/27/2018 PERM #I i-. C) I — 6) 01 <br />Owner u orized Agent Signature Date (Revised 912312016) <br />0 <br />