2615 BROADWAY QFC 2021-09-22 - Laserfiche WebLink

• PERMIT APPLICATION. D ti---1 BUILDING I MECHANICAL/PLUMBING/SIGN /SPRINK /D o T'n g CITY OF EVERETT PERMIT SERVICES J V 9� � ' EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.eve p s :� o f : z (Blue or Black Ink Only Please) PROJECT SITE INFORMATION � . PROJECT SITE ADDRESS: Zto 15 jPr>a D w Pr t/ PROPERTY TAX#: 0O4 3gii,O 7 O D IOo LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: 5P tJ Fs RD MAR...Ctq H 1-ReFVn owe TENANT BUSINESS NAME(Commercial): Cl F G OWNER MAILING ADDRESS: STREET fl 1 .1-6 RR 1044,6 DR CITY c`?f\sni-tOPV S K STATE V/it ZIP gC q o OWNER PHONE: 7 S 3 qg 7- 5 ?b I OWNER EMAIL: pt s L . S A,`I-o$ 26 Q (S1 < e .C Orn CONTRACTOR NAME: ADVANCCA cic,NJ LCC_ CONTRACTOR ADDRESS: STREET 1 A 3-7-^ 1<T W N SI E - C CITY P tJ 6 V A J v STATE 1 . ZIP gT Q Q I CONTRACTOR PHONE: 2 5 . 9S7 ' 5`IOa CONTRACTOR EMAIL: A 5 L , 5Ary wS , Rage 6Ina('1,COrr‘ CONTRACTOR LICENSE#(REQUIRED):A I)V PtNS L q is P? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Of r'` \ PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2 5 3 _ 9$-7_ 5q0 t ROt.og 5A NTO S CONTACT EMAIL: /ISL. ,SA NTd S, 1 `: 6-t011.+?,Ct?M BUILDING INFORMATION Existing Use of Building: Z;T(5 2.j. Contract Price of Work:$ 2i Soo ,39— Proposed Use of Building: S*-1 ot- Heat Source: ❑Gas ❑Electric DOther BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Aign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: I NJ STALt.P1T(od'-1 OF N1✓W t,6-1) ►I.t.OMINATEb ( NNVL to TrEt2SeTr To Con ace— po u) R TO cx t S'r) J C' C t RGu rr ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures 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 Ventilation Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) 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: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System I 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. / City of Everett Official Use Only 1 7 Z lzoll PERMIT# Oi„t O er/ ed •ge.t Si Date (Revised 10/10/2018) /