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PLUMBING PERMIT APPLICATION <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) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 9900 lsth Ave. SE PARCEL M 20851800405400 <br />CITY Everett STATE WA ZIP 98208 <br />SUITE/UNIT M FLOOR M 1 ADDITIONAL LOCATION INFORMATION: Del/Seafood Department <br />TENANT/BUSINESS NAME (if non-residential): WinCo Foods, LLC <br />CONTACT INFORMATION <br />OWNER NAME: WinCo Foods, LLC <br />OWNER MAILING ADDRESS: STREET 650 N. Armstrong <br />CITY Boise STATE ID ZIP 83704 <br />OWNER PHONE: (208) 377-0110 <br />OWNER EMAIL: Michael.Tran@wincofoods.com <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: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR F11 OTHER (Please Specify) Applicant <br />CONTACT NAME: <br />Ryan Barnett <br />CONTACT PHONE: (208) 258-6155 <br />CONTACT EMAIL:rbarnett@bhillsarch.com <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 30,000.00 ASSOCIATED PERMIT # (if applicable): <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: OCommercial ❑Accessory Structure <br />DESCRIPTION OF WORK: Replace service seafood/dell cases with self -Serve cases. <br />Add half walls and replace floor sinks. <br />PLUMBING PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA <br />Shower, Tub, or Combo <br />1 <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 />2 <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />2 <br />Other (List Type): Floor sink <br />Sewage Ejector Pump/Sump Pump <br />1 <br />1 Other (List Type): <br />ACKNOWLEDGEMENT: / 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 />City of Everett Official Use Only <br />03/28/2025 PERMIT # <br />Date (Revised 412112022) <br />