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MOBILE FOOD PREPARATION Permit Number: FMFV2311-001 <br /> Permit Type: MOBILE FOOD PREPARATION <br /> VEHICLE PERMIT VEHICLE <br /> FVERIETT City of Everett Permit Subtype: <br /> WASHINGTON Date Issued: 12/4/2023 <br /> PERMIT INFORMATION: <br /> SITE ADDRESS: 3027 Broadway PARCEL#: <br /> DESCRIPTION: Everett fire permit TENANT: <br /> CONTACT INFORMATION: <br /> OWNER: PHONE: <br /> MAILING ADDRESS: EMAIL: <br /> APPLICANT: Betty Chavez PHONE: (425)246-5985 <br /> MAILING ADDRESS: 409 state Avenue Marysville,WA 98270 EMAIL: Pupusasana757@gmail.com <br /> CONTRACTOR: Betty Chavez PHONE:425 <br /> MAILING ADDRESS: 409 state Avenue Marysville,WA 98270 EMAIL: Pupusasana757@gmail.com <br /> STATE CONTRACTOR'S LIC#: EVERETT BUSINESS LIC#: <br /> PERMIT FEES: <br /> DESCRIPTION COMMENTS QUANTITY FEE AMOUNT DATE PAID <br /> FIRE REVIEW FEE 0 $88.00 12/4/2023 <br /> Percent Credit Card Fee 0 $2.02 12/4/2023 <br /> TOTAL:$90.02 <br /> PERMIT DETAILS: <br /> Name of Mobile Food Vehicle: Pupusas Ana LLC Cooking Suppression System: <br /> Vehicle Description: Ford 2015 Portable Fire Extinguishers: <br /> License Plate Number: C11615N LP Tanks: <br /> List of Cooking Appliances: Grill, stove, microwave, deep fryer. Date of Last Fire Inspection: <br /> L& I Number:V3201 Fire Jurisdiction of Last Inspection: <br /> PERMIT CONDITIONS: <br /> CONDITION TYPE CONTACT DATE ADDED DATE REQUIRED DATE SATISFIED STATUS REMARKS <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> By purchasing this permit and commencing work,the owner/applicant hereby agrees to hold and save harmless the City of Everett from any and <br /> all claims for damages, costs,expenses, or causes of action that may arise because of installation and maintenance of the improvement or other <br /> right-of-way use here to applied for and further agrees to remove same upon notice from the City and to replace public property damaged <br /> thereby. <br /> E V E R E T T Permit No.: FMFV2311-001 Page 1 of 2 <br /> WASHINGTON <br />