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PERMIT APPLICATION <br /> #111°P417-4 <br /> BUILDINCIIIECHANICAL/ PLUMBING /SIGN /41411INKLER/ DEMOLITION <br /> 4410' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (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: 1140 l'eitCCON W.Pct:.( PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Walmart R. E. Bus.Trust TENANT NAME(If Commercial): Walmart#5195 <br /> OWNER MAILING ADDRESS: STREET 2001 SE 10th Street <br /> cr Y Bentonville STATE AR ZIP 72716 <br /> OWNER PHONE: 4797„---,_--1. : OWNER EMAIL: peter.clement@walmart.com <br /> CONTRACTOR •ME ,.4,_0J /r �✓ <br /> CONTRACTOR •DDRESS: STREET <br /> CITY STATE - ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED):bocci)d.,L2t4 11�IEITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 9S9 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ®OTHER(Please Specify) Agent - <br /> CONTACT NAME: CONTACT PHONE:918-877-6000 x279 <br /> Jackie Waggnor c/o Cyntergy CONTACT EMAIL: jwaggnor@cyntergy.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Retail/Grocery Contract Price of Work:$ - $660,000 <br /> Proposed Use of Building: Retail/Grocery Heat Source: jij Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: u clal ['Industrial <br /> Type of Project: ONew DAddition ®Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Interior Cosmetic Remodel <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 ••it <br /> #of #of #of #of <br /> List of Fixtures fist of Fixtures List of Fixtures List of fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow P•-venter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Dri. ing Fountain <br /> Water Heater Refrigeration Shower %'oor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hoo,Jps Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/ .p/etc.) Other: <br /> SPRINKL- ' /SUPPRESSION SYSTEM <br /> Chemi :I or Water I No.of Heads <br /> ACKNOWLEDG ENT:I have reviewed this application and confirm the information contained -rein 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 a 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!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMI <br /> 04/11/18 � ( <br /> Owner/Authorized Agent Signature Date (Revised 9/ 016) <br />