208 74TH ST SE 2023-09-14 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box, WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E) PermitServices@everettwa.gov I(W)everetlwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 208 74th St SE PARCEL#: C FFY Everett STATE wa ZIP 9820 SUITEWNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: U le Londo T OWNER MAILING ADDRESS: STREET Q d 6* 1:2 6 Vee CITY STATE i ZIP OWNER PHONE:425-422-5283 OWNER EMAIL: c.,,L'1 e C0Y1 d0 d {NIA 1 L C°0M CONTRACTOR COMPANY NAME:Owner WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE:425-422-5283 CONTRACTOR EMAIL: PRIMARY CONTACT: Z OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:Julie Londo CONTACT PHONE:425-422-5283 CONTACT EMAIL: '7W1 e L Af L PLUMBING PERMIT INFORMATION VALUATION OF WORK: $3,000 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: R SFR ❑Townhouse ❑Du lex ❑ADU ❑Multi-Family-#Units: ❑Commercial ElAccessory Structure DESCRIPTION OF WORK:Replacing old plumbing materials that were vandalized and destroyed 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 Fire 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 WastelWater Pipe Repair Ice Maker Iwater Service Line(Behind meter,private side) Grease Interceptor lWater Valves/Fixtures Sand/Oil Interceptor I Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump Other(List Type): ACKNOWLEDGEMENT:/have reviev.ed 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 cork and no deviations therefrom.Deviations must first be authorized in writing from the 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 vork 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 PERMIT# ��O Owne"1120iorized Agent .g ature Date (Revised 4/21/202 )