1502 100TH ST SW 2023-12-11 - 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)425.257.88101(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET J f 10 v 1.�1 PARCEL#: CITY L STATE ZIP SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY STATE w ZIP OWNER PHONE: — OWNER EMAIL: ` CO, CONTRACTOR COMPANY NAME: OW N WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)- CONTRACTOR ADDRESS: STREET Cay STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: [X OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: — CONTACT EMAIL: v t 11111 PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ 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: INSFR []Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: 1 PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture �7 Fixture "� Count List of Fixtures R-QC��—/V 'T ( ►I k"' Count List of Fixtures (Qty) -P S T ;l (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) 1 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.t 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, t to Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 0 ) / D I PERMIT# ?2303 — 003 Owner/Authorized Agent Signature Date (Revised 2/8/2021)