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PLUMBING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />[elk Wc.]MAN 40:009UANt",1kW11:IWA ral*1 <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 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET i S ( 5 (J PARCEL #: <br />�JQ/'� j <br />{� <br />CRY C- L l,._V �"\ STATE 1 / ZIP O <br />SUITE/UNIT #: FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): <br />CONTACT INFORMATION <br />OWNER NAME: L i A) o c) fz- Q-,t <br />OWNER MAILING ADDRESS: STREET o2 Cif l 5 i,v <br />CITY [ J �r STATE �-LJ l� ZIP D a <br />OWNER PHONE: Z 5 0 '— 7& 0 <br />OWNER EMAIL: t 0 C'_ r.-{- P S ) vO j/yts V1 oy—, <br />CONTRACTOR COMPANY NAME: u l ':S0 k ►7 50 n V (n k t r'1 <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): R u 11 JT L 10 PI $ CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET o( us 5C ( p a d <br />CITY I-, STATE j�j ZIP q ga D <br />CONTRACTOR PHONE: 1 Zj ~ -26 v 15 D <br />1CONTRACTOR EMAIL: <br />PRIMARY CONTACT: JKOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />L (nCi� C 0 J C e <br />CONTACT PHONE: -(Z ` - v <br />1-7 <br />CONTACT EMAIL: 3 ve. ba. re S 10 0 �� JY✓l <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 3006 O O 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: KSFR ❑Townhouse []Duplex ❑ADU ❑Multi -Family- # Units: ❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK" G II�lriL1`p CU ri Pl c-S -D PEX Ih S ho LL)e( q l 5 <br />ckon c6PPp-,( P;� 10 �E-�C t^�tD -r(A NC s (A K5/Fauce:_Ts� tot lc;t <br />N��Y fi vb <br />PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qfy) <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 />Drinking Fountain <br />Toilet <br />Floor Drain <br />Urinal <br />Hose Bibb <br />Waste/Water Pipe Repair <br />Ice Maker <br />Water Service Line (Behind meter, private side) <br />Grease Interceptor <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />Other (List Type): <br />Sewage Ejector Pump/Sump Pump I <br />10ther (List Type): <br />ACKNOWLEDGEMENT:1 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 I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Caw 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 412112022) <br />CL. <br />