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PAMBING PERMIT APPLICAN <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.8810 ( (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET 10330 EVERGREEN WAY PARCEL #: 00535200001400 <br />CITY EVERETT STATE WA zip 98204 <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): GLINT CAR WASH <br />CONTACT INFORMATION <br />OWNER NAME: SERJ DEVELOPMENTS, LLC <br />OWNER MAILING ADDRESS: STREET 1500 EAST KATELLA AVENUE #5 <br />CITY ORANGE STATE CA Zip 92867 <br />OWNER PHONE: (425) 577-8556 <br />OWNER EMAIL: runeh@kiddermathews.com <br />_'-)CONTRACTOR COMPANY N E: TBD MA N a k KYa IO I U 4 b In G- U9&=i.Ekt I <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUI D): <br />' J <br />CONTRACTOR ADDRESS: STREET V Q e D,X 962D "I 24I <br />CITY VAL G V{� STATE � ZIP � l <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 55,000.00 <br />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: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: Install all plumbing for tenant improvement bathrooms, plumbing, mop sink, gas piping <br />for car wash. <br />PLUMBING PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(QtY) <br />List of Fixtures <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA <br />Shower, Tub, or Combo <br />Commercial Sink (3-compartment, prep, floor) <br />Clothes Washer <br />Residential Sink (kitchen, bath, bar) <br />Dishwasher <br />Utility Sink (laundry, mop) <br />+ <br />Drinking Fountain <br />Toilet <br />Floor Drain <br />Urinal <br />+ <br />Hose Bibb <br />Waste/Water Pipe Repair <br />Ice Maker <br />Water Service Line (Behind meter, private side) <br />Grease Interceptor <br />+ <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />3 <br />Roof Drains <br />Other (List Type): <br />Sewage Ejector Pump/Sump Pump <br />Other (List Type): <br />ACKNOWLEDGEMENT.- / 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. 1 am the owner. or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Eric Koch--- <br />Owner/Authorized Agent Signature <br />9/10/2021 <br />Date <br />City of Everett Official Use Only <br />PERMIT # FZ�C)j <br />(Revised 21812021) <br />