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ii <br />EVERETT <br />WASHINGTON <br />PLL* JNG PERMIT APPLICATI■ <br />—4ITY 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) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Onty Please) PROJECT SITE INFORMATION : „ ., <br />PROJECT SITE ADDRESS: STREET 1010 N. BROADWAY PARCEL #: 210 IZZI12A <br />CITYEVERETT STATE WA <br />n i <br />LL-- 6 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INF <br />ATION: <br />TENANT/BUSINESS NAME (if non-residential): STARBUCKS #22817 - BROADWAY & 10TH <br />CONTACT':INFORMATION '("` <br />OWNER NAME: STARBUCKS CORPORATION PerCnl arvices <br />OWNER MAILING ADDRESS: STREET 2401 UTAH AVENUE SOUTH, MS STOPS-SDS10 <br />CITY SEATTLE STATE WA z,P 98134 <br />OWNER PHONE: 206-318-1575 <br />OWNER EMAIL: <br />CONTRACTOR COMPANY NAME: TBD <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑✓ OTHER (Please Specify) ARCHITECT <br />CONTACT NAME: <br />J I M F I EG E <br />CONTACT PHONE: 585-313-8007 <br />CONTACT EMAIL: GDG.STARBUCKS@GRAPHITEDESIGNGROUP.COM <br />PLUIIABING' PERIVIIT INFORMATION <br />VALUATION OF WORK: $ 50,000 <br />ASSOCIATED PERMIT # (if applicable): 6 <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 []Duplex ❑ADU ❑Multi -Family - # Units: ✓❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: Providingupdated plumbing supply and plumbing waste to new equipment locations. <br />p p 9 ppY p 9 <br />new floor sinks and fixtures per fixture count below. <br />PLUMBING PERMIT FIXTURE„COUNT <br />($COPEOF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />O <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA <br />Shower, Tub, or Combo <br />+ <br />Commercial Sink (3-compartment, prep, floor) <br />Clothes Washer <br />Residential Sink (kitchen, bath, bar) <br />Dishwasher <br />+ <br />Utility Sink (laundry, mop) <br />Drinking Fountain <br />Toilet <br />+ <br />Floor Drain <br />Urinal <br />Hose Bibb <br />+ <br />Waste/Water Pipe Repair <br />Ice Maker <br />lWater Service Line (Behind meter, private side) <br />Grease Interceptor <br />27 <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: I 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. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCWWd 296.200A WAC. <br />a4 <br />10/30/23 <br />Date <br />City of Everett Official Use Only <br />PERMIT # PA317-c)(6 <br />(Revised 412112022) <br />