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PERMIT APPLICATION,,I°IIm <br /> �/— BUILDIN�ECHANICAL/PLUMBING/SIGN I <br /> SPRINKLER'' /DEMOLITION <br /> „411- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4410 Rucker Ave PROPERTY TAX#: 00407800603900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Steve Totem TENANT NAME(If Commercial): Totem Family Diner <br /> OWNER MAILING ADDRESS: STREET 4410 Rucker Ave <br /> carr Everett STATE WA ZIP 98203 <br /> OWNER PHONE: 425.877.9127 ,OWNER EMAIL: Steve@totemdiner.com <br /> CONTRACTOR NAME: Interstate Industries Inc <br /> CONTRACTOR ADDRESS: STREET 1217 4th Ave N <br /> CITY Kent STATE WA ZIP 98032 <br /> CONTRACTOR PHONE: 253.886.4008 CONTRACTOR EMAIL:Bobbie.interstate@gmail.com <br /> CONTRACTOR LICENSE#(REQUIRED): INTERII873D7 CITY OF EVERETT BUSINESS LICENSE r� jJ <br /> *(REQUIRED):% 9 <br /> PRIMARY CONTACT: D OWNER COCONTRACTOR 0 OTHER(Please Specify) /�" f✓ <br /> CONTACT NAME: CONTACT PHONE: 253.886.4008 or 206.850.9819 <br /> Don Angeline CONTACT EMAIL: <br /> Bobbie.interstate@gmail.com <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Restaurant Contract Price of Work:$ 8,979.00 <br /> Proposed Use of Building: Restaurant Heat Source: C$Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 121Commercial ❑Industrial <br /> Type of Project: [New ❑Addition ❑Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Installation of 1 10"Class 1 Interstate Hood,exhaust fan,and make up air. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn g,Alteration Repair Type of Project: New Addn _Alteration Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures--- <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> 1 Range Hood Water Heater Other: <br /> 1 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads. <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this pennit 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.lam the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 1a27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 9664 5't 5.3.16 PERMIT# M (O®'_00–7 q <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />