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PLOIIBING PERMIT APPLICATO <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 10312 EVERGREEN WAY PARCEL #: 00535200001001 <br />CITY EVERETT STATE WA ZIP 98204 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): SONIC DRIVE-IN <br />CONTACT INFORMATION <br />OWNER NAME: SERJ DRIVE-INS WASHINGTON <br />OWNER MAILING ADDRESS: STREET 1500 EAST KATELLA AVENUE #5 <br />CITY ORANGE STATE CA Zip 92867 <br />OWNER PHONE: 657-223-9133 <br />OWNER EMAIL: jasmin@serjgroup.com <br />CONTRACTOR COMPANY NAME: TO BE DETERMINED Y14, b� <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />IttAbAl') JV <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET -� <br />CITY �I� STATE �� ZIP <br />CONTRACTOR PHONE: <br />[CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ✓❑ OTHER (Please Specify) "RCMTEC'T <br />CONTACT NAME: <br />E R I C KO C H <br />CONTACT PHONE: 425-636-8006 <br />CONTACT EMAIL: eric@padgi.com <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 75,000 <br />ASSOCIATED PERMIT # (if applica e : B2106-023 �. <br />(Valuation shall Include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Du lex ❑ADU ❑Multi -Family- # Units: ❑✓ Commercial ElAccessory Structure <br />DESCRIPTION OF WORK: CONSTRUCTION OF NEW FAST FOOD RESTAURANT <br />i�WYrlil� I �1 <br />PLUMBING PERMIT FIXTURE <br />COUNT <br />(SCOPE OF WORK <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />7 <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑✓ DCVA <br />Shower, Tub. or Combo <br />Commercial Sink (3-compartment, prep, floor) <br />Clothes Washer <br />Residential Sink (kitchen, bath, bar) <br />Dishwasher <br />Utility Sink (laundry, mop) <br />Drinking Fountain <br />Toilet <br />Floor Drain <br />Urinal <br />Hose Bibb <br />Waste/Water Pipe Repair <br />Ice Maker <br />Water Service Line (Behind meter, private side) <br />Grease Interceptor <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />Other (List Type): <br />Sewage Ejector Pump/Sump Pump <br />Other (List Type): <br />ACKNOWLEDGEMENT: 1 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. 1 am 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 />Eric Koch �:---- <br />Owner/Authorized Agent Signature <br />1 /6/2022 <br />Date <br />City of Everett Official Use Only <br />PERMIT��J <br />(Revised 21812021) <br />1/L <br />