9113 9TH AVE SE 2023-06-23 - Laserfiche WebLink

— • • PLUMBING PERMIT APPLICATION EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES 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)everetteps@everettwa.gov 1(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 77!!/ 3 9 fi rt- h �� 3 L PARCEL#: g 7 CrrY V e r'e STATE V" V'� ZIP ?,7Z CI( SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): j ' CONTACT INFORMATION OWNER NAME: V T 5 e 6 OWNER MAILING ADDRESS: STREET CRY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: JJ,L L s pi U r b , n Qt,s WA STATE CONTRACTOR LICENSE#(REQUIRED): pc 8;LC s p G CITY OF EVERETT BUSINESS LICENSE#(REQUIRE ): J RJ' CONTRACTOR ADDRESS: STREET {1 S 19' 2'7 p d A / I Q� S o ' 9 ). d 4 CITY Cj S I� I 1 STATE w q ZIP 9�2�O CONTRACTOR PHONE: L yV T Se CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER LONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:I I >^/ CONTACT PHONE: 4 2 S 3 (1y 9 9 b VV 07 CONTACT EMAIL: PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ 3 S'OO 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 ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: VUI 0L I, a 14- �v S 442 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: / Shower,Tub,or Combo JpgjFire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) Clothes Washer / Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain / 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.lam the owner,or)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 (rir 9-2y -ao 27 Owner/Authorized Agent Signature Date (Revis 2/8/2021)