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PLSVIBING PERMIT APPLICAN <br /> EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES <br /> 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.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 4208 Rucker Ave PARCEL#: 00582202300801 <br /> cln. Everett STATE WA ZIP 98201 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): At Your Leisure Services, LLC <br /> CONTACT INFORMATION <br /> OWNER NAME: Charmae, LLC <br /> OWNER MAILING ADDRESS: STREET 3815 Colby Ave <br /> CITY Everett STATE WA ZIP 98201 <br /> OWNER PHONE: 425-339-4158 OWNER EMAIL: li <br /> sa@atyourleisure.net <br /> CONTRACTOR COMPANY NAME: New Heating & Cooling, LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): NEWHEHC842BO CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 61275 <br /> CONTRACTOR ADDRESS: STREET 8425 219th St. SE. Suite 102 <br /> CITY Woodenville STATE WA ZIP 98072 <br /> CONTRACTOR PHONE: (425) 280-1734 CONTRACTOR EMAIL: newhcsystems@gmail.COm <br /> PRIMARY CONTACT: ❑OWNER ✓❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ''' CONTACT PHONE: 425-280-0527 <br /> Milan d Cordell CONTACT EMAIL: newhcsystems@gmail.com <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $ 1,500 ASSOCIATED PERMIT#(if applicable): ('2-b5. <br /> (Valuation shall include the prevailinged fair market value of all labor,materials,and equipment need to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse Duplex ❑ADU ❑Multi-Family-#Units: ) Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK:Installation of cold water to 2 tankless water heaters with hot water to washing <br /> machines. Installation of hot and cold water to 5 washing machines with drains. <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 /> 5 Clothes Washer 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 /> 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 2 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 /> PERMIT# <br /> 12/14/2021 F2-Z03 -OD 6 <br /> Owner/Authorized Agent S gn ur Date (Revised 2/8/2021) <br />