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E PLIII.BING PERMIT APPLICATION <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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> �t ��.<. ' . ', ► ,siy ' scjt[tca.�rExr i arr'�`=� rl�rar�"7[ <br /> PROJECT SITE ADDRESS: STREET 11108 Evergreen Way Suite E PARCEL#: 00442900300700 <br /> crry Everett STATE Wash. ZIP 98204 <br /> SUITE/UNIT#: E FLOOR#: t ADDITIONAL LOCATION INFORMATION: <br /> ITFNANT/RIISINESSNAmF(ifnnn-ragidentiai):Ak rn Market <br /> CONTACT IH1 ORMA TtON <br /> OWNER NAME:Enat Wendemeneh <br /> OWNER MAILING ADDRESS: STREET 11108 Evergreen Way Suite E <br /> ow Everett cTe,F_Wash. ZIp 98204 <br /> OWNER PHONE:"• 8 2_06 3 qg 99S D OWNER EMAIL: I <br /> CONTRACTOR COMPANY NAME:TBD. r ,V-1,0 S i Gl/l.(.- CO M 5 I S e ry 1 CAS <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):CA-P L- 0 H Ci O 41-ge CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (p('7 7$ <br /> CON-TRACTOR eDDREcc._ STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> [CONTACT EMAIL: <br /> i?►it�lfll iPl9Y.7y ERMIT INFfRMATIO <br /> VALUATION OF WORK:$10,000 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: USER ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑✓Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK:Plumbing for grease trap and kitchen sinks and mop sink. <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (QtY) (Qry1 <br /> Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA 3 Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer Residential Sink(kitchen,bath,bar) <br /> Dishwasher h Utility Sink(laundry,mop) <br /> Drinking Fountain Toilet <br /> Floor Drain Urinal <br /> Hose Bibb Waste/Water Pipe Repair <br /> Ice Maker Water Service Line(Behind meter,private 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.lam the owner,or!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 /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 2/8/2021) <br />