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� L <br /> PLUMBING PERMIT APPLICATIGDMAR 15 2023 <br /> EVER ET T CITY OF EVERETT PERMITSERVICES CITY OF <br /> SUBMITTAL INSTRUCTIONS:Drop off hard copy completed paper application t0 3200 C $� E YE.ft, e,D op Box <br /> WASNINGT w CONTACT INFORMATION:(P)425-257-8810 j(E)PermitSeMces@everettwa.gov ( ever>'11 � 4 iEs <br /> (Blue or Stack ink Only Please) PROJECT SITE INFORMATION. <br /> PROJECT 5!T ADDRESS: STREET r <br /> t PARCEL#: <br /> CITY r {�.-4^}- STATE LV ('\ -ZIP <I t' 'L3 <br /> SUITEMNIT M FLOOR MI <br /> ADDITIgNAL LOCATION INFORMAI'tQN: <br /> TENANT/BUSINESS NAME(if non-fesidential): { <br /> CONTACT INFORMATION <br /> OWNER NAME <br /> OWNER MAILING ADDRESS: sTrsee r i <br /> 4 <br /> CITY _ Lr\1\4 `Lt-C', t • STATE <br /> OWNER PHON OWNER EMAIL., `' s k ca i <br /> i \1 1 Ct-ti 1 [ _1`1 <br /> CONTRACTOR,COMPANY NAME; t7 W <br /> WA STATE CO TRACTOR LICENSE#(REQUIRE : CI F EVeRVITT—BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STA-ME ZlP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CON CT: &OWNER 0 CONTRACTOR Q OTHER(Please Specify) <br /> CONTACT NA E: CONTACT PHONE: _nL_r= �. <br /> CONTACT EMAIL,. <br /> PLUMBING PERMIT INFORMATION,.. <br /> ffVALUATION WORK:� - 0 ASSOCIATED PERMIT#(if a licabfe: <br /> a the pr Eng la' ma el value ofal laor,mtquipment needed to comp'We the work,whmiieractE: SFR []Townhouse ❑Duplex OADU 0Multi-Family-#Units: OCommerciat 13Accessory Stru lure <br /> DESCRIPTION FWO ; 'V r t�V\, S4\atS: .�` a 'CT�n+r�. . t\�. `7 <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List o IFixlures Count List of Fixtures } <br /> (Q(Y) taty) f <br /> Backtl w Prevention Device(Inside Building) select devices below: ower, ub,or Combo <br /> Fire Service:13DCDA, Domestic Service:13RPOA❑DCVA mmercial Sfnk(3•camparimant,prep,floor) <br /> Clothe Washer Residential Sink(kitchen,'bath,bar) <br /> Dishwasher Utility Sink(laundry,rn ) <br /> Drinkin Fountain Toilet <br /> 1 Floor D-ain Urinal <br /> Hose B bb Waste/Water Pipe Repair <br /> Ice M er Wafer Service Line(Behind meter,prvate side) <br /> Grease <br /> II--tnerceptor Water Valvesimmures <br /> SarTtUOit Interceptor Wafer Heater•Electric <br /> Medica Gas Roof Dins Water Heater-Gas <br /> raOther(List T <br /> Sevrag pe);_Ejector Pump/Sump Pump Other(List Type): _ ----- <br /> ACKNOWLEDGE <br /> --ACKNOWLEDGEMNT:I h4vO reviewed this applkatlon and confirm the lnforrnallon contained herein is true T <br /> and Iand correct.Work <br /> current federal,sclone pursuant to this permit must comp! r+rth <br /> tarotl local y. ire granting of a permit only authorizes appraved work and no dotdatlons fherefrnrn.Deviations must first be authorised in writing fro a the <br /> Building Official beforla being authorized under any circumstance.lain the owner,or 1 am aultiorizzod by the owner of this property.to petform the work for tivlrlch 6pplicalic r 4 made <br /> and t comply will,tin State COMM(OrS Law 18.27 RCW and 296.200A WAC. <br /> t [fly of Everett Official Use Only <br /> h PERMIT# <br /> Owner/Authorized gentSignature Date <br /> i (RBvisedA/21rb ) <br />