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.... <br /> n. PLuMBING PERMIT APPLICATION <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 (` J J <br /> PROJECT SITE ADDRESS: STREET '(g Tech ti 5�1 PARCEL#: 'YB O o 5-4 plod I S 1-1`e.4. <br /> CITY thv/e re STATE Ohl- ZIP IgZD 3 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME: /11 iClii r ( `//1/1 (+l'1 <br /> OWNER MAILING ADDRESS: STREET f OX 22116" p <br /> `[ CITY �,1 a j STATE ZIP g3L.9 O 3 <br /> OWNER PHONE: GI Z6 ¶L s"' 3�6 OWNER EMAIL: <br /> j f eri A►eJ Q4 cI fl4Gf(t Go/'!i <br /> CONTRACTOR COMPANY NAME: c h r/sdt 11 S #00/CS y `1l-c <br /> WA STATE CONTRACTOR LICENSE#(REQUI{{RED):G yJ 2-538TJ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6• 311 <br /> CONTRACTOR ADDRESS: STREET POI 6oX 2 t(5 <br /> CITY KI 1 1 VV,g h at STATE ZIP L 3 <br /> CONTRACTOR PHONE: -1 K-eilf;- {.5-q CONTRACTOR EMAIL: .1,reeie Filmt $likY4(/e Lei" <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: , -v <f- (,t1 CONTACT PHONE: l- e11 g-y 35- <br /> It{ `I t CONTACT EMAIL: j Kee_refLf yI Gg.Crot(/ 9 <br /> PLUMBING PERMIT INFORMATION J <br /> VALUATION OF WORK: $ '$ 000 ASSOCIATED PERMIT#(if applicable): g Z//0—Dy8 <br /> (Valuation shall include the pr ailing fair/market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: iNiliSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> 1; hem (Ai bihj, ww5h-iv y-, wa �t- X`f�rxx <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: 3 Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> ( Clothes Washer 6 Residential Sink(kitchen,bath,bar) <br /> I Dishwasher I Utility Sink(laundry,mop) <br /> Drinking Fountain '3 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 I 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 /> e <br /> 7:- ' PERMIT# tt1 0 v-a�� <br /> / �a��/z� � ` <br /> Owne Authorized Agent Signature Date (Revised 2/8/2021) <br />