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4010 172nd Street NE_BLD1530_2026
COMMERCIAL REMODEL ' PERMIT APPLICATION Department of Community& Economic Development City of Arlington• 18204 59th Ave NE •Arlington, WA 98223 • Phone(360) 403-3551 THIS APPLICATION MUST BE ACCOMPANIED BY TWO(2)SETS OF CONSTRUCTION PLANS,TWO(2) SETS OF SPECIFICATIONS,TWO(2)SETS OF STRUCTURAL CALCULATIONS,ONE(1)SETS OF NREC ENERGY CODE APPLICATIONS AND ONE(1) OCCUPANTS'S STATEMENT OF INTENDED USE. Type of Permit: ( ) Commercial Remodel O Commercial Addition (X) Tenant Improvement Project Address: 4010 172nd Street NE Parcel ID#: 00930300000301 Project Description: interior rework for pickup area Legal Description: see attached Project Valuation: 40,000 Owner: Walmart Phone Number: Address: PO Box 8050 City: Bentonville State: AR Zip Code: 72716 Contact Person:Sara Baker/HFA Phone Number: Cell Phone: E-mail: sara.baker@hfa-ae.com Address: 1705 S Walton Blvd City: Bentonville State: AR Zip Code: 72712 Contractor: TBD Phone Number. Address: City: State: Zip Code: Contractor's License Number: Expiration: Plumbing Contractor: Phone Number: Address: C ty State: Zip Code: Contractor's License Number: Expiration: Mechanical Contractor: Phone Number: Address: City: State: Zip Code: Contractor's License Number: Expiration: REV 2015 Page 6 of 7 ` XV -� COMMERCIAL REMODEL PERMIT APPLICATION Department of Community & Economic Development City of Arlington• 18204 59th Ave NE •Arlington, WA 98223 • Phone(360) 403-3551 Project Name/Tenant Walmart#3757 - EOTF Site Address4010 172nd St NE Bldg./Unit/Suite IBC Construction Type _ IBC Occupancy Type Description of Use Mercantile Building Square Footage .155,543 Number of Stories 1 Square Footage per Floor 155,543 Will there be any installation, modification or removal of the following? (Check all that apply) ❑ Automatic fire extinguishing systemsautomatic sprinklers only ❑ Compressed gas systems ❑ Fire alarm and detection systems ❑ Fire pumps ❑ Flammable and combustible liquids (tanks,piping etc...) ❑ Hazardous materials ❑ High piled/rack storage ❑ Industrial ovens/furnace ❑ Private fire hydrants ❑ Spraying or dipping operations ❑ Standpipe systems ❑ Temporary membrane structure, tents (>200sq ft)or canopies (>400 sq ft) Provide details on any of the above checked items: Installation,changes, modifications or removal of any of the above may require additional submittals,information,or permits during the plan review or construction process. hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-described property will be in accordance with the laws, rules and regulation of the State of Washington. 7 Sara Baker ",, ao xs,Ynw Applicants Si atu Sara Baker 6/20/2017 Print Applicants Name Date FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received REV 2015 Page 7 of 7 CITY OF ARLINGTON 238 N.OLYMPIC AVE-ARLINGTON,WA. 98223 PHONE;(360)403-3551 BUILDING PERMIT Address:4010172ad Street N£ Permit#:1530 Parcel#:00930300000301 Valuation:40000.00 OWNER APPLICANT CONTRACTOR Name:WAL-MART STORES INC Name:HFA Name:Powerhouse Retail Services,LLC Address:PO BOX 8050 MIS 0555 Address:1705 S Walton Blvd Address:812 S Crowley Road,Suite A City,State Zip:BENTONVILLE,AR 72712-8050 City,State Zip:Bentonville,AR 72712 City,State Zip:Crowley,TX 76036 Phone: Phone:479-273-7780 x302 Phone: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Alteration CODE YEAR: 2015 STORIES: ] CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: I OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT 1S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC 1 IO/IRC110. SNnF N TICE:Sales tax ating to construction and construction materials in the City.of r ingioi:!Vt., on your sales tax return form d c lingto 2 � r7 to Print Name Date Released by Date CONDITIONS Adhere to approved plans. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 8/3/2017 Building Permit Fee $768.18 8/3/2017 Building Plan Review Fee $499.32 8/3/2017 Processinglrechnology Fee $25.00 8/3/2017 State Building Code Surcharge Fee $4.50 Total Due: $1,297.00 Total Payment: $499.32 Balance Due: $797.68 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: CITY OF ARLINGTON 238 N. OLYMPIC AVE -ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:4010 172nd Street NE Permit#:1530 Parcel#:00930300000301 Valuation:40000.00 OWNER APPLICANT CONTRACTOR Name:WAL-MART STORES INC Name:HFA Name:Powerhouse Retail Services,LLC Address:PO BOX 8050 M/S 0555 Address:1705 S Walton Blvd Address:812 S Crowley Road,Suite A City,State Zip:BENTONVILLE,AR 72712-8050 City,State Zip:Bentonville,AR 72712 City,State Zip:Crowley,TX 76036 Phone: Phone:479-273-7780 x302 Phone: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Alteration CODE YEAR: 2015 STORIES: I CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: I OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, IBC1I0/IRC110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City ofAW itigto�bere on your sales tax return form and coded City of Arlington#3101. Signature Print Name Date Released INy Date CONDITIONS Adhere to approved plans. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 8/3/2017 Building Permit Fee $768.18 8/3/2017 Building Plan Review Fee $499.32 8/3/2017 Processing/Technology Fee $25.00 8/3/2017 State Building Code Surcharge Fee $4.50 Total Due: $1,297.00 Total Payment: $499 32 Balance Due: $797.68 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON,WA.98223 PHONE;(360)403-3551 BUILDING P9RMITf Address:4010172ad Street NE Permit#:1530 Parcel 4:009303000W301 Valuation:40000.00 OWNER APPLICANT CONTRACTOR Name:WAL-MART STORES INC Name:HFA Name:Powerhouse Retail Services,LLC Address:PO BOX 8050 M/S 0555 Address:1705 S Walton Blvd Address:812 S Crowley Road,Suite A City,State Zip:BENTONVILLE,AR 72 7 1 2-90 50 City,State Zip:Bentonville,AR 72712 City,State Zip:Crowley,TX 76036 Phone: Phone:479-273-7780 x302 Phone: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Alteration CODE YEAR: 2015 STORIES: I CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: I OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED TIIEREBY-.NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LA30R CODE.OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 19.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. lT lS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE,UNTIL A FINAL.INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC[IO/IRCI l0. S. F">A N T •Sales tax 1 ting to construction and construction materials in the City of{lrlington in>!s be rt on your sales tax return form d c d "fingto .— tuRK Print Name Date Rcicascti By Dale CONDITIONS Adhere to approved plans. THIS PERMIT AU1'HORIL.S ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION PERWr FEES Date Description Fee Amount 8/3/2017 Building Permit Fee $768.18 8/3/2017 Building Plan Review Fee $499 32 8/3/2017 Processing/Technology Fee $25 DO 8/3/2017 State Building Code Surcharge Fee $4.50 Total Due: S1,297.00 Total Payment: $499.32 Balance Due: S797.68 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the fallowing ioformatlon: f CITY OF ARLINGTON e 238 N. OLYMPIC AVE-ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:4010 172nd Street NE Permit#:1530 Parcel#:00930300000301 Valuation:40000.00 OWNER APPLICANT CONTRACTOR Name:WAL-MART STORES INC Name:HFA Name:Powerhouse Retail Services,LLC Address:PO BOX 8050 MIS 0555 Address:1705 S Walton Blvd Address:812 S Crowley Road,Suite A City,State Zip:BENTONVILLE,AR 72712-8050 City,State Zip:Bentonville,AR 72712 City,State Zip:Crowley,,TX 76036 Phone: Phone:479-273-7780 x302 Phone: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Alteration CODE YEAR: 2015 STORIES: I CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: I OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC IOARCI 10. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the CiY-orqiffg-(owl be re ort on your sales tax return form and coded City of Arlington#3101. 7 Signature Print Name Date Released by Date CONDITIONS Adhere to approved plans. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 8/3/2017 Building Permit Fee $768.18 8/3/2017 Building Plan Review Fee $499.32 8/3/2017 Processing/Technology Fee $25.00 8/3/2017 State Building Code Surcharge Fee $4.50 Total Due: $1,297.00 Total Payment: $499.32 Balance Due: $797.68 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon Permit Information Date 6/28/2017 Permit Number 1530 Project Name Walmart Applicant Name HFA Applicant Address 1705 S Walton Blvd City,State,Zip Bentonville,AR 72712 Contact Sara Baker Phone 479-273-7780 x302 Email sara.baker@hfa-ae.com Permit Type Commercial Alteration Site Address 4010 172nd Street NE Valuation 40000.00 Status Applied Permit Issued Permit Expires Square Feet 155543 Type of Construction/Occupancy Load Number of Stories 1 Proposed Use Alteration for grocery pick up area Assigned To Property Information Owner Information Parcel#:00930300000301 WAL-MART STORES INC WAL-MART STORES INC PO BOX 8050 M/S 0555 4010 172nd Street NE BENTONVILLE,AR 72712-8050 Review Date Type Description Target Date Completed Dat-e---F Assigned To Status 3/29/2017 lCommercial T.I. 7/6/2017 1 PW-Wat-Rev 111n Review Fees Fee Description Notes Amount Building Plan Review Feel 345.83.00.001 $499.32 Totall $499.3 Payments Date Paid By Amount Description Payment Type Acce ted B 6/29/2017 JSara Baker $499.32 35329425 'c Totall $499.3 Amount Outstanding:$0.0 Notes Date Note 6/28/2017 contractor TBD. Uploaded Files Upload File Date File Uploaded By 1 6/28/2017 4A3 12 PM 11530 Application pdf Foster.Kristin IX ' r COMMERCIAL REMODEL PERMIT APPLICATION Department of Community & Economic Development City of Arlington• 18204 59th Ave NE •Arlington, WA 98223 • Phone(360) 403-3551 THIS APPLICATION MUST BE ACCOMPANIED BY TWO(2)SETS OF CONSTRUCTION PLANS,TWO(2) SETS OF SPECIFICATIONS, TWO(2)SETS OF STRUCTURAL CALCULATIONS,ONE(1)SETS OF NREC ENERGY CODE APPLICATIONS AND ONE(l) OCCUPANTS'S STATEMENT OF INTENDED USE. Type of Permit: ( ) Commercial Remodel ( ) Commercial Addition (X) Tenant Improvement Project Address: 4010 172nd Street NE Parcel ID#: 00930300000301 Project Description: interior rework for pickup area Legal Description: see attached Project Valuation: 40.000 Owner: Walmart Phone Number: Address: PO Box 8050 City: Bentonville State: AR Zip Code: 72716 Contact Person:Sara Baker/HFA Phone Number: Cell Phone. E-mail: sara.baker@hfa-ae.com Address: 1705 S Walton Blvd City: Bentonville State: AR Zip Code: 72712 Contractor: TBD Phone Number: Address: City: State: Zip Code: Contractor's License Number: Expiration: Plumbing Contractor: Phone Number: Address: City State: Zip Code: Contractor's License Number: Expiration: Mechanical Contractor: Phone Number: Address: _ City: State: Zip Code: Contractor's License Number: Expiration: Received JUN 2 3 top REV 2015 Page 6 of 7 i COMMERCIAL REMODEL PERMIT APPLICATION Department of Community & Economic Development City of Arlington• 18204 59th Ave NE •Arlington, WA 98223 • Phone(360) 403-3551 Project Name/Tenant Walmart#3757- EOTF Site Address 4010 172nd St NE Bldg./Unit/Suite IBC Construction Type IBC Occupancy Type Description of Use Mercantile Building Square Footage 155,543 Number of Stories 1 Square Footage per Floor 155,543 Will there be any installation, modification or removal of the following? (Check all that apply) Q Automatic fire extinguishing system sa utomati c sprinklers only ❑ Compressed gas systems ❑ Fire alarm and detection systems ❑ Fire pumps ❑ Flammable and combustible liquids(tanks,piping etc...) ❑ Hazardous materials ❑ High piled/rack storage ❑ Industrial ovens/furnace ❑ Private fire hydrants ❑ Spraying or dipping operations ❑ Standpipe systems ❑ Temporary membrane structure, tents (>200sq ft)or canopies (>400 sq ft) Provide detlils on any of the above checked items: Installation,changes, modifications or removal of any of the above may require additional submittals,Information,or permits during the plan review or construction process. hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-described property will be in accordance with the laws, rules and regulation of the State of Washington. 7 Sara Baker t aPNbl 0500' Applicants SIR 561� Sara Baker 6/20/2017 Print Applicants Name Date FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received REV 2015 Page 7 of 7 LETTER OF TRANSMITTAL To: City of Arlington Date: June 20, 2017 Dpt of Community& Economic Dev. Project No: 22-17-40007 18204 59th Ave NE Project: Walmart#3757 Arlignton WA Arlington WA 98223 4010 172nd Street NE Arlington WA 98223 Attn: Plan Review Intake Subject: Building Permit Plan Review OTP Please find the following items for your use with the above referenced project. If you have any questions or need additional information,please contact me. Copies Description 2 Plans 1 Building Permit Application If enclosures are not as noted,please notify our office immediately. Sincerely, Sara Baker 479-273-7780 Ext: 302 Sara.Baker(a)-hfa-ae.corn **UPS Overnight** Received JUN 2 3 2017 1705 S Walton Blvd,Suite 3 Harrison French Associates Phone:479-273-7780 Bentonville,AR 72712 www.hfa-ae.com Fax:888-520-9685 8/3/2017 POWERHOUSE RETAIL SERVICES LLC 1 ,pn,,••r �.: Search L&I Clafms&insurarc=' `Xc)( ;lace Rjl j its ?rades Px l icei,:sing A^ Washington State Department of " Labor & Industries POWERHOUSE RETAIL SERVICES LLC Owner or tradesperson 812 S Crowley Rd. Principals Suite ACROWLEY,TX 76036 TEETER,BRENT HARRY,PARTNER/MEMBER 817-297-8575 Doing business as POWERHOUSE RETAIL SERVICES LLC WA UBI No. Business type 603 151 119 Limited Liability Company Parent company Governing persons POWERHOUSE PARTNERS LLC JEFFREY DAVID HARGRAVE MICHAEL PATRICK MURPHY; BRENT HARRY TEETER; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. POWERRS883KA Effective—expiration 04/3012012—04/3012018 Bond Philadelphia Indemnity Ins Co $12,000.00 Bond account no. PB00271200073 Received by L&I Effective date 03/23/2015 04/19/2015 Expiration date Until Canceled Bond history Insurance National Fire Ins of Hartford $1,000,000.00 Policy no. 5082984796 Received by L&I Effective date 02/13/2017 02101/2017 Expiration date 02/01/2018 Insurance history Savings No savings accounts during the previous 6 year period. Help us inipr,eve https://secure.Ini.wa.gov/verify/Detaii.aspx?UBI=603151119&LIC=POWERRS883KA&SAW= 1/2 8/3/2017 1 —. POWERHOUSE RETAIL SERVICES LLC Lawsuits against the bond or savings ' No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 234,849-00 Doing business as POWEHOUSE RETAIL SERVICES LLC Estimated workers reported Quarter 1 of Year 2017"0"Workers L&I account contact T3/KENT ANDERSON(360)902-6963-Email:ANDN235@lni.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept,of Labor&Industries.Use of this site is subject to the laws of the state of Washington, HOP us irylpr'ov,� hftps://secure.Ini.wa.gov/verify/Detail.aspx?UBI=603151119&LIC=POW ERRS883KA&SAW= 2/2 I Inspection Information Inspection Date 10/17/2017 Type Commericial Requested By Contact Info Scheduled Date Completion Date 10/24/2017 Description Status Approved Assigned To Hours 0 Notes Property Information Parcel#:00930300000301 WAL-MART STORES INC WAL-MART STORES INC PO BOX 8050 M/S 0555 010 172nd Street NE BENTONVILLE AR 72712-8050 569 Other Retail Trade-Apparel&Accessories NEC Inspection Items Date Employee Pass/Fail Note Building Final 10/24/2017 Kevin Pass Olander Ceiling Grid 10/24/2017 Kevin Pass Missing rivets opposing wall.Corrected 10/24 verified w/photos. Olander APPROVED Cross Connection Fire Final Footing Foundation Framing 10/16/2017 Kevin Pass Framing approved pending L&I rough in approval. 10/16/17 KO. Olander Gas Piping Groundwork Plumbing Insulation Rough HVAC Rough-In Plumbing Shearwall Structural slab Underfloor Wallboard Permit Details Date 6/28/2017 Permit Number 1530 Project Name Wal-Mart Applicant Name HFA Applicant Address 1705 S Walton Blvd City, State,Zip Bentonville,AR 72712 Contact Sara Baker Phone 479-273-7780 x302 Email sara.baker@hfa-ae.com Permit Type Commercial Alteration Site Address 4010 172nd Street NE Valuation 40000.00 Status Completed Permit Issued 9/27/2017 Permit Expires Square Feet 155543 Type of Construction/Occupancy Load Number of Stories 1 Proposed Use Alteration for grocery pick up area Assigned To Contractors Contractor Name Primary Phone Email Contractor License License# Contact Type UHC United Heating and Cindy 440-550- rhamad@uhccorp.com CONTRACTOR Labor and UHCUNUH882RP Cooling,LLC Hamad 14995 Industries Property Information Owner Information Parcel#:00930300000301 WAL-MART STORES INC WAL-MART STORES INC PO BOX 8050 M/S 0555 4010 172nd Street NE BENTONVILLE,AR 72712-8050 Permit#: 1530 Permit Date: 06/28/17 Permit Type: COMM HZCIAL ALTERATION Project Name Wal-Mart Applicant Nam e HFA Applicant Address: 1705 S Walton Blvd Applicant, City, State, Zip: Bentonville,AR 72712 Contact: Sara Baker Phone: 479-273-7780 x302 Em al: sara.baker@hfa-ae.com Scope of Work: Alteration for grocery pick up area Valuation: 40000.00 Square Feet: 155543 Num ber of Stories: 1 Construction Type: O xupancy G ioup: ID Code: Permit Issued: 09/27/2017 Permit Expires: Form Permit Type: Status: LASERFICHE Assigned To: Property Parcel# Address L egal Description O wrier Nam e Cvner Phone Zoning WAL-MART 569 Other Retail 00930300000301 4 010 172nd Street NE STORES INC Trade-Apparel& Accessories NEC Contractors Contractor P rim ay Contact P hone A ddress C ontractor Type L icense License# UHC United Heating CONSTRUCTION Labor and and Cooling,LLC Cindy Ham xl 4 40-550-4995 4 1 Leonard Ave CONTRACTOR Industries UHCUNUH882RP Inspections Date I nspection Type D escription S cheduled Date C om lieted Date I nspector S tatus 10/24/2017 C 00.RACKING S torage racking anchor bolts 10/24/2017 B UILDING A pproved in place 2-each pad opposite corners. 10/17/2017 C20.BUILDING 10/24/2017 A pproved FINAL Plan Reviews Date Review Type D escription A ssigned To R eview Status 06/29/2017 COMMIRCIAL z.Rick Karns ALTERATION Fees Fee D escription N otes A m cunt Building Plan Review T able 4-2 $499.32 Building Perm i T able 4-1 $768.18 Processing/Technology $25.00 State Surcharge- 1st DU R esidential- 1st Unit $4.50 Total $1,297.00 Attached Letters Date Letter D escription 08/03/2017 Building Perm i Paym arts Date Paid By D escription P aym art Type A ccepted By A m Cant 06/29/2017 Sara Baker 6 5329425 c c $499.32 08/07/2017 Sara Baker 6 5830230 c c $797.68 O ttstanding Balance $0.00 Notes Date Note C reated By: 08/21/2017 Verify contractor that will be perform hg the work(Powerhouse Retail or UHC) K ristin Foster 08/03/2017 Contractor info received.KF K ristin Foster 06/28/2017 Contractor TBD. 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V! ❑ r 3 T p m STORE NO:3757-223 AUTHORAUTHOR"NAND"BEONIFA"°TTTO w "z s v "• JOB NUMBER: 22-17-40007 EOTF Eaw' Rr �w J I PRINTED:5%31/2017 2:0g PM BY:Brandon Brewley LAST SAVED:5/3112017 2:09 PM BY:Brandon.brawley kA22\22-17-40007 arlington,we 3757\Flre\condocs\2100-fpi fire sprinkler plans and general notes-3757.dwg it �D SC) mA mRWj. 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