10521 19TH AVE SE NEW LEAF PHO 2023-06-23

• • PERMIT APPLICATION 1 BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:10521 19th Avenue SE, Suite 100 PROPERTY TAX#:280520-002-030-00 LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Kin Wa Chan TENANT BUSINESS NAME(Commercial): New Leaf Pho OWNER MAILING ADDRESS: STREET 1432 173rd Street SW ar, Lynnwood STATE WA ZIP 98037 OWNER PHONE: 360-990-0836 OWNER EMAIL:bluewhalechemical@gmail.com CONTRACTOR NAME:Kin Wa Chan CONTRACTOR ADDRESS: STREET 1432 173rd ST SW CITY Lynnwood STATE WA ZIP 98037 CONTRACTOR PHONE:360-990-08 NTRACTOR EMAIL:bluewhalechemical@gmail.com NN.\\ CONTRACTOR LICENSE#(REQUIRED:BLUEWWC823P9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED. PRIMARY CONTACT: ❑OWNER CONTRACTOR Do HER(Please Specify) TLS Consulting Engineers CONTACT NAME: CONTACT PHONE:206-853-5728 Quyen Nguyen CONTACT EMAIL:quyenseattle@gmail.com BUILDING INFORMATION Existing Use of Building:Mixed Use Contract Price of Work:$70000 Proposed Use of Building:Business Heat Source: I,LlGas ❑Electric ❑Other BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure Type of Project: LiNew ❑Addition ❑Remodel ❑Repair ©T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Tenant improvement for a restaurant. No structural work. ASSOCIATED BUILDING PERMIT#(if applicab14-111703-824 cT eEt f MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI TION Fixture ' Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC—Air Handling Units 'K Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas R e Clothes Washer 'X Sink-Commercial(3-comp,prep,floor) CI es Dryer He ump&Ductless ' .'.hwasher Sink-Residential(kitchen,bath,bar) Duct stem(Remodel) frigeration Drink • Fountain Sink-Utility,laundry,mop Exhaust ans(Residential) Commercial Ventilation Floor Dra .Y Toilet _Exhaust Ho (Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood pe II) NA Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Re dential Wood Stove Interceptor-San• Oil Water Service(behind meter) Forced Air Systems Other: Medical Ga \ Water Valves or Fixtures Gas Fireplace/InserU og Roof Dr.' s ,j' Water Heater SPRINKLER/ PPR ON SYSTEM Se .•e Ejector or Sump Pump er: Water Suppression Syste No.of Heads (Chemical Suppression stem No.of Heads ACKNOWLEDGEMEN :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 deviati ns therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by t 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 D35 Owner/Authorized Agent Signature Date (Revised 10/10/2018) 24