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PIaIMBING PERMIT APPLICA> N <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 I(E)everetteps@everettwa.uov i(W i everetrwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 1208 Rucker Ave PARCEL#: <br /> cry Everett STATE WA zip 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:Jay & Joy Varady <br /> OWNER MAILING ADDRESS: STREET 1208 Rucker Ave <br /> c,n Everett STATE WA ZIP 98201 <br /> OWNER PHONE:(425) 299-0433 OWNER EMAIL:knox.joy@gmail.corn <br /> CONTRACTOR COMPANY NAME: Curtiss Construction Co., Inc. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CURTICC995PA CITY OF EVERETT BUSINESS LICENSE ti REQUIRED): 039553 <br /> CONTRACTOR ADDRESS: sTREET8303 143rd Ave NE <br /> c,r Lake Stevens STATE WA ZIP 98258 <br /> CONTRACTOR PHONE:(425) 239-2941 CONTRACTOR EMAIL:CUrtiSS@CUrtiSSCOr1StrUCtIOr1CO.COm <br /> PRIMARY CONTACT: ❑OWNER ✓❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425) 239-2941 <br /> Curtiss B. Fiechtner CONTACT EMAIL:curtiss@curtissconstructionco.corn <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $56':I0.00 ASSOCIATED PERMIT#(if applicable): <br /> (Valuation shall include the prevaili,•Jairmarket value of al abor.materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ✓❑SF- ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial EAccessory Structure <br /> DESCRIPTION OF WORK:Master Bath Remodel <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: 2 Shower,Tub,or Combo <br /> Fire Service: ❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> i Clothes Washer 2 Residential Sink(kitchen,bath, bar) <br /> Dishwasher Utility Sink(laundry,mop) <br /> Drinking Fountain t Toilet <br /> Floor Drain Urinal <br /> Hose Bibb Waste/Water Pipe Repair <br /> Ice Maker Water Service Line(Behind meter,pnvate side) <br /> Grease Interceptor 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!comply with the State Contractors aw 18.27 RCW and 296.200A WAC. <br /> ") City of Everett Official Use Only <br /> ti <br /> 3 ( \ 12'1 <br /> RMI <br /> Owner/Authorized Ag4tt SIglat) Date (Rev, d 2/8/2021) <br />