8102 EVERGREEN WAY MALL KIOSK EVERETT 4 CORNERS - MAIL KIOSK 2025-08-06

PERMIT APPLICATION EVERETT WASHINGTON BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits Blue or Black Ink Only Please PROJECT SITE INFORMATION PROJECT SITE ADDRESS: 8102 Evergreen Way PROPERTY TAX #: 28050700307000 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Four Corners, LLC TENANT BUSINESS NAME (Commercial): Four Corners Apartments OWNER MAILING ADDRESS: STREET 19000 NE 8th Street, Suite 1200 c,n Bellevue STATE WA zip 98004 OWNER PHONE: 425-453-9551 OWNER EMAIL: tom.neubauer@heartlandwa.com CONTRACTOR NAME: Heartland Construction LLC CONTRACTOR ADDRESS: STREET 10900 NE 8th Street, Suite 1200 an Bellevue STATE WA ZIP 98004 CONTRACTOR PHONE: 425-453-9551 CONTRACTOR EMAIL: tom.neubauer@ heartlandwa.com CONTRACTOR LICENSE #(REQUIRED): HEARTCL8280F CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 60418 PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR El OTHER (Please Specify) Architect CONTACT NAME: Seth Terry CONTACT PHONE: 206-204_1 CONTACT EMAIL: setht )oh raund.co BUILDING INFORMATION'' Existing Use of Building: Vacant Contract Price of W rk: $ Proposed Use of Building. Trash Enclosure Heat Source: ❑Ga ❑Electric her n/a BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: - I ❑Commercjdl ❑✓ Accessory Structure Type of Project: ✓❑New ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign ❑Sprink r 1:11DemoliP6 ❑Chan e of Use DESCRIPTION OF WORK: "Four Corners Apartments - Mail Kiosk" -- Construct a ne ail ki structure. E ASSOCIATED BUILDING PERMIT # (if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures Fixture Count List of Fixtures A/C — Air Handling Units Gas Piping Backflow Preventer (Inside Bldg) Shower, Tub, or Combo Boiler Gas Range Clothes Washer Sink -Commercial (3-comp,prep, floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink -Residential (kitchen, bath, bar) Duct System (Remodel) Refrigeration Drinking Fountain Sink -Utility, laundry, mop Exhaust Fans (Residential) Commercial Ventilatior (Not Heat/AC system) I Floor Drain IToilet Exhaust Hood (Type 1) I Hose Bibb Urinal Exhaust Hood (Type II) Water Heater Interceptor -Grease Waste/Water Piping Repair Exhaust Hood (Residential) Wood Stove Interceptor-Sand/Oil Water Service (behind meter) Forced Air Systems Other: I Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log I Roof Drains Water Heater SPRINKLER / SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No. of Heads Chemical Suppression System No. of Heads 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 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 Building Official before being authorized under any circumstance. 1 am the owner, or / am authorized by the owner of this property to perform the work for which application is madr_. and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. Signature M - Zoto Date City of Everett Official Use Only PERMITfg 21 cal— o►� (Revised 1011012018)