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• • <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />E a��REss: �601 Evergreen Way, # E001 <br />LEGAL for new construction: Short Plat/subdiv <br />rrvER Regency Centers <br />lress 5335 SW Meadows # 295 <br />PLICANT: _ Owner � Owner's Agent <br />NTRACTOR TB D <br />NAME <br />Dollar Tree <br />ROPERTY TAX # <br /># <br />. _ - _ �,�,.�.� <br />No. (attach copy of long legal description) <br />Phone/E-mail 503.603.4709 <br />City/StatelZip Lake Osweqo, OR, 97035 <br />ContraCtOl' _ ContfaCtof'S Agent _ Tenant (must provide a lefler of ccnsent trom ihe oe�mer to do work in the space) <br />BUILDING PERMIT APPLICATION <br />State Lic. #�,t{�/�-�LC� L oY�l('ltEity Bus. Lic. <br />Phone/Email <br />Andy Paroline/ andy@parolineassociates.com <br />Phone/E-mail �F'j ']� C� ���� <br />CONTRACT PRICE OF WORK <br />Existing Use of Building Grocerv HEAT SOURCE: <br />Proposed Use of Building Retail/ Grocery Gas� Electric other_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family X Commercial <br />Type of project: New Addition Remodel X Repair T.I. Si n Sprinkler Demolition Chan e of Use <br />DESCRIPTION OF WORK (additionalspace providcxJ on the back) : <br />Interior remodel for a new Dollar Tree: partition walls, food coolers, restrooms, shelving, <br />ceiling, finishes, etc per plan <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New_Addn �Alteration _Repair <br />Show Number (#J of fiztures <br />A/C — air handling units <br />Forced air s stems <br />� ' Gas i in <br />Water heater i <br />' Gas fire lace <br />' Gas ran e <br />Clothes dr er <br />Ran e hood <br />Exhaust fan <br />Heat pum <br />' Unit he er <br />Boil <br />' fri eration <br />I oodstove <br />—� Ductin <br />Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />� Number of Heads <br />PLUMBING PERMIT APPLICATION <br />of Project: _New_Addn �Alteration _Repair <br />Show Nurnber (#) of fixtures <br />2 Toilet <br />Bathtub <br />2 � Lavatory (wash basin) <br />Sho��!er <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes wash�r <br />—�' Water heat�r <br />� I Sink ser ice/bar/mo /etc. <br />—'—' Backfl preventer <br />Urin <br />Dr kin Fountain <br />oor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and I<now the same to be true and correcL All provisions of laws and ordinances governing this type of worl<will be compl <br />oviUi whether specified herein or noL The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of his pr p ty to perfonn the worl< for which applicatipn is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� �-� . 2 �• ��5 <br />OwnerlAuthorized Agent Signa re Date (Revised 9/2014) <br />