Laserfiche WebLink
PLMBING PERMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425.257.8810 l(E)everetteps@everettwa.gov i(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 7204 6th Ave W PARCEL#: 00708000003800 <br /> c,TY Everett STATE WA ZIP 98203 <br /> SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:Kerri (Tronson) Bell <br /> OWNER MAILING ADDRESS: sTREET72O4 6th Ave W <br /> CITY Everett STATE WA ZIP 98203 <br /> OWNER PHONE:425-478-3786 OWNER EMAIL:kerritl @hotmaiI.COrn <br /> CONTRACTOR COMPANY NAME:JOh-SOM and Sons Construction LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):jOhnSSC921 kZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 51651 <br /> CONTRACTOR ADDRESS: STREET6618 Marine View Drive <br /> CITY Edmonds STATE WA ZIP 98026 <br /> CONTRACTOR PHONE:425-299-5616 CONTRACTOR EMAIL:JASCONSTNW@GMAIL.COM <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-299-5616 <br /> Vic Johnson CONTACT EMAIL:JASCONSTNW@GMAIL.COM <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK:AN 3( A 0 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: I]SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: ❑Commercial EAccessory Structure <br /> DESCRIPTION OF WORK:Connect new faucet, sink, dishwasher, ice/water box for refrigerator <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer t Residential Sink(kitchen,bath,bar) <br /> Dishwasher Utility Sink(laundry,mop) <br /> Drinking Fountain Toilet <br /> Floor Drain Urinal <br /> Hose Bibb Waste/Water Pipe Repair <br /> i Ice Maker Water Service Line(Behind meter,private side) <br /> Grease Interceptor t Water Valves/Fixtures <br /> Sand/Oil Interceptor Water Heater-Electric <br /> Medical Gas Water Heater-Gas <br /> Roof Drains Other(List Type): <br /> Sewage Ejector Pump/Sump Pump 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 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3 (C �' Z PERMIT#[)�t — C31 <br /> Owner/Authprized ent Signature Date (Revised 2/8/2021) <br />