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0 0 <br /> 111111111 PERMIT APPLICATION <br /> LT <br /> BUILDING /MECHANICAL/PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET.EVERETT.WA 98201 <br /> u-c (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 SITE INFORMATION <br /> PROJECT SITE ADDRESS: 12906 Bothell Everett Hwy, Everett, WA 98208 PROPERTY TAX#: , <br /> LEGAL for new construction. Sheri Plat/subdivision Lot No (attach copy of long legal description) <br /> CONTACT INFORMATION , <br /> OWNER NAME: Fred Meyer TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: sTREFT 3800 SE 22nd Ave. <br /> cm, Portland STATE Or. 7_r 97202 <br /> OWNER PHONE: OWNER EMAIL: <br /> Ymmilsommssmsamiromismaimmissmsassizw <br /> CONTRACTOR NAME: Polar Refrigeration Inc. I <br /> CONTRACTOR ADDRESS: STREET 8819 NE 117th Ave. STE A. <br /> ,,,y Vancouver STATE WA br, 98662 <br /> CONTRACTOR PHONE: 9712184510 CONTRACTOR EMAIL: anthony@polar-refrigeratiOn.net <br /> CONTRACTOR LICENSE#(REQUIRED): POLARRI948KC CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Applied <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 971-21 8-4510 <br /> ANTHONY RICO CONTACT EMAIL: anthony@polar-refrigeration.net <br /> BUILDING INFORMATION <br /> Existing Use of Building Grocery Store Contract Price of Work:$-St90,594.00 <br /> Proposed Use of Building Grocery Store Heat Source ❑Gas ❑Electric ❑Other 1 <br /> BUILDING USE ❑SFR ❑Townhouse [JDuplex ❑ADU ❑Multi-Family-#Units__ ❑Commercial DAccessory Structure <br /> Type of Project ❑New L)Addition E(Remodel ❑Repair ❑T I. LSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Refrigeration conversion from R-22 to R407A. Replacing 25 cases inside store with like for like <br /> ASSOCIATED BUILDING PERMIT#(if applicable) '..J11.5 0Li-6 , <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture F,:rum Fixture Fixture <br /> Count List of Fixtures count of Fixtures Count List of Fixtures Count List of Fixtures <br /> ANC -Air Handhng 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 Unnal <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 Other Medical Gas WaterWater Valves or Fixtures <br /> Fireplace/Insert/Log <br /> Gas Roof Drains Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Elector or Sump Pump Other <br /> Wafer 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 authonzed in writing from the <br /> Building Off, or ein authonzed under any circumstance /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 co :y with the Sta ontractors Law 18 27 RCW and 296 200A WAC <br /> City of/ii <br /> Everett Official Use Only <br /> cp PERNtI� 0 0 'i 02;j <br /> O erAuth . ed kg nt Signature Date (Revised 10/10/2018) <br /> 6 zo-v(1- 0),i5 <br />