710 MADISON ST 2023-05-23 - Laserfiche WebLink

vim P•MBING PERMIT APPLICAOON EVERETT CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 I (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 710 Madison Street PARCEL#: 00393300000902 CITY Everett STATE WA ZIP 98204 SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: Tewordros Haile OWNER MAILING ADDRESS: STREET 710 Madison Street cITY Everett STATE WA ZIP 98155 OWNER PHONE: 425-4953612 OWNER EMAIL: wubneh2003@aol.com CONTRACTOR COMPANY NAME: Homeowner WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ✓❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425-4953612 Wubneh Asefa CONTACT EMAIL: wubneh2003@aol.com PLUMBING PERMIT INFORMATION VALUATION OF WORK: $ 7500.00 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑✓SFR ❑Townhouse EDuplex EADU ❑Multi-Family-#Units: ECommercial ❑Accessory Structure DESCRIPTION OF WORK: Interior addition and alterations PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (Qty) Backflow Prevention Device(Inside Building)-select devices below: i Shower,Tub,or Combo Fire Service: ❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) Clothes Washer 3 Residential Sink(kitchen,bath,bar) t Dishwasher Utility Sink(laundry,mop) Drinking Fountain 2 Toilet Floor Drain Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker Water Service Line(Behind meter,private side) Grease Interceptor Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump Other(List Type): 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only /12 6-16-2022 PERMIT# �Z� - G 7 3 Owner/Authorized Agent Signature Date (Revised 4/21/2022)