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FJMBING PERMIT APPLICS'ION <br /> E V E R E T T SUBMITTAL INSTRUCTIONS: <br /> OF EVERETT PERMIT SERVICES <br /> S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 9602 Everegreen Way PARCEL#: 00480200300700 <br /> ln. Everett STATE Wash. ZIP 98204 <br /> SUITE/UNIT#: FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):Imrans Market II <br /> CONTACT INFORMATION <br /> OWNER NAME:Faraz Qureshi <br /> OWNER MAILING ADDRESS: STREET 11501 HWY 99 <br /> CITY Everett STATE Wash. ZIP 98204 <br /> OWNER PHONE:425-610-4215 OWNER EMAIL:gUreShiaCe@yahOO.COm <br /> CONTRACTOR COMPANY NAME:TBD ,S e (/` W& .t c WA STATE CONTRACTOR LICENSE#(REQUIRED):5efl ra P g 11-R0 iciTy OF EVERETT BUSINESS LICENSE#(REQUIRED): 561 D 3 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Architect <br /> CONTACT NAME: CONTACT PHONE:206-283-8317 <br /> William Page CONTACT EMAIL:pagearch@whidbeyisland.com <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $10,000 ASSOCIATED PERMIT#(if applicable): - 3.2-\(0t-A f 0jZ <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: ❑SFR ElTownhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ✓❑Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK:Floor drain, two hand sinks, mop sink and three compartment sink. <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo <br /> Fire Service: ❑DCDA, Domestic Service:❑RPBA❑DCVA 3 Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer Residential Sink(kitchen,bath,bar) <br /> Dishwasher 1 Utility Sink(laundry,mop) <br /> Drinking Fountain Toilet <br /> I Floor Drain Urinal <br /> Hose Bibb Waste/Water Pipe Repair <br /> Ice Maker Water Service Line(Behind meter,private side) <br /> Grease Interceptor Water Valves/Fixtures <br /> Sand/Oil Interceptor Water Heater-Electric <br /> Medical Gas Water Heater-Gas <br /> Roof Drains Other(List Type): <br /> Sewage Ejector Pump/Sump Pump Other(List Type): <br /> 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 <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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT IAD <br /> 6- <br /> Owne Auliorized Agent Signature L/ Date (Revised 2/8/2021) <br /> l/Z <br />