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477. PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: 4128 Rucker Ave. PROPERTY TAX#: 00582101401700 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Safeway, Inc TENANT NAME(If Commercial): Starbucks <br /> OWNER MAILING ADDRESS: STREET 1371 Orchard Blvd., #200 <br /> cnv Walnut Creek STATE CA ZIP 94596 <br /> OWNER PHONE: 425 201-6411 OWNER EMAIL: joe.janus@safeway.com <br /> CONTRACTOR NAME: Tricon Commercial Construction <br /> CONTRACTOR ADDRESS: STREET 385 Old Corvalis Road - <br /> crry Hamilton STATE MT ZIP 59040 \, <br /> CONTRACTOR PHONE: 406 381-3785 CONTRACTOR EMAIL: billr@tc-const.com it <br /> CONTRACTOR LICENSE#(REQUIRED): TRI COCC881 JO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)1 ,054243 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR RI OTHER(Please Specify) Architect I <br /> CONTACT NAME: Brian Elliott CONTACT PHONE: 206 519-5145 V.--- i <br /> CONTACT EMAIL: brian.elliott@graphitedesigngroup. m <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Retail (M) Contract Price of Work:$ '7)000 <br /> Proposed Use of Building: Retail (M) Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ®Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ®Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> _. _...�.. .��.w.... ...�... ....�..- - st1 'g, ............ A <br /> tlteJatinnq to rbimhing- <br /> 1_ <br /> (ASSOCIATED BUILDING PERMIT#(if applicable): __ - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: New Addn _ Alteration _Repair <br /> #of #'1)List of Fixtures #of List of Fixtures List of Fixtures #of of Fixtures <br /> Fixtures Fixtures Fixture Fixtures <br /> A/C-Air Handling Units Heat Pump ilet tfacktlow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatoly„(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower 1 Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&1DisRo'sal 1 Grease Trap <br /> Gas Range Ducting Dishwasher ,/ -®�-__ Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Fater Other: <br /> Exhaust Fan 2 Siok�.(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I 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.lam the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE #t <br /> 11-30-17 ( -eio l <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />