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PERMIT APPLICATIO <br /> BUILDINSVIECHANICAL/ PLUMBING / SIGN PRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:12906 Bothell Everctt I Iwy • furl. lk-ue__ PROPERTY TAX#:28053000406200 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Fred Meyer Stores Inc TENANT BUSINESS NAME(Commercial): Fred Meyer <br /> OWNER MAILING ADDRESS: STREET3800 SE 22nd <br /> i <br /> ciTy Portland STATE OR ZIP 97200 <br /> OWNER PHONE: 503-797-3526 OWNER EMAIL:nick.breninger@kroger.com <br /> CONTRACTOR NAME:TX. t /.-is-tS \r‘,Jr_50-v.rec, e-17.4.x_kp J <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) )(a(N % (1 S22CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):LELE,(Q <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR El OTHER(Please Specify) Michael Chen - Mackenzie <br /> CONTACT NAME: CONTACT PHONE:206-749-9993 <br /> Michael Chen CONTACT EMAIL:mchen@mcknze.com <br /> BUILDING INFORMATION <br /> Existing Use of Building:Retail-Grocery Store Contract Price of Work: tog t SO 0 . 0 c <br /> Proposed Use of Building:Retail-Grocery Store Heat Source: EGas DElectric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑✓T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Within the walls remodel of existing store. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT 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 /> 0 A/C-Air Handling Units 0 Gas Piping - ` 0 Backflow Preventer(Inside Bldg) 0 Shower,TO,or Combo <br /> 0 "Bo Or 0 Gas Range Clothes Washer 0 Sink—Cmercial(3-comp,prep,floor) <br /> 0 Clothe's Bryer 0 #eat Pump&Ductless . Dishwasher 0 - 'Sink-Residential(kitchen,bath,bar) <br /> 1 Duct System(Remodel) ,0 "-Drinking <br /> -'- Refrigeration 0 Driug Fountain ' 0 n Sink-Utility,laundry,mop <br /> 0 Exhaust Fans(Resident. 0 Commercial Ventilation 5 Floor DraTrr 0 Toilet <br /> 0 Exhaust Hood(Typejy r_(Not Heat/AC system) 0 Hose Bibb 0 Urinal <br /> 0 Exhaust Hood,9Type II) -0'.--_,Water Heater 0 Interceptor-Gr e 0 Waste/Water Piping Repair <br /> 0 Exhaust I.eod(Residential) 0 WaodStove 0 Intercep - and/Oil 0 Water Service(behind meter) <br /> 0 Forc Air Systems Other: - 0 Medical Gas 0 ater Valves or Fixtures <br /> 0 Fireplace/Insert/Log 0 /Roof Drains 0 Water ater <br /> SrRINKLER/ SUPPRESSION SYSTEM /6 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 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 /> PERMLT#12 0 ` LI � II?) <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) 11 7— <br />