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PLWBING PERMIT APPLICATTN <br /> EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES <br /> INSTRUCTIONS: 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) i 7( , PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET,,i7 W.MARINE VIEW DR. PARCEL#: 29051800400500 <br /> clTv Everett STATE WA zip 98201 <br /> SUITE/UNIT#: N/A FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME (if non-residential):WOODS COFFEE <br /> CONTACT INFORMATION <br /> OWNER NAME:TAYLOR HERMAN-WOODS COFFEE <br /> OWNER MAILING ADDRESS: STREET 191 18TH ST <br /> CITY LYNDEN STATE WA Zip 98264 <br /> OWNER PHONE:360.393.7553 OWNER EMAIL:TAYLORH@WOODSCOFFEE.COM <br /> CONTRACTOR COMPANY NAME:CONTRACT HAS NOT BEEN AWARDED o v l <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):VALLEK qq CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): G L 43,k3g <br /> CONTRACTOR ADDRESS: STREET <br /> '�C ( () L„) fiI �N , ( <br /> cm( �/ / itAA"5- STATE t/LIA.- ZIP 9,31f <br /> ?� <br /> CONTRACTOR PHONE: 300-_9. o-�� ( CONTRACTOR EMAIL: ;T - �V A L&P , <br /> PRIMARY CONTACT: ) OWNER H CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:360.393.7553 <br /> TAYLOR HERMAN CONTACT EMAIL:TAYLORH@WOODSCOFFEE.COM <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $15,000 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: L1SFR LlTownhouse 7 Duplex ❑ADU flMulti-Family-#Units:_ ..Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: UNDERGROUND ROUGHT WASTE LINE AND WATER SUPPLY, ROUGH WALL WATER <br /> SUPLY, FIXTURE AND TRIM, VENTING PENETRATIONS PER ENGINEERED PLAN. <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (QtY) <br /> A Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub.or Combo <br /> Fire Service: ❑DCDA. Domestic Service: I1-1RPBA HDCVA Commercial Sink(3-compartment. prep,floor) <br /> • Clothes Washer Residential Sink(kitchen.bath,bar) <br /> Dishwasher • Utility Sink(laundry, mop) <br /> Drinking Fountain Toilet <br /> 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 5 Other(List Type): FLOOR SINK <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 Wing 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, tete Contractors Law 18.27 RCW and 296.200A WAC. <br /> // City of Everett Official Use Only <br /> PERMIT# <br /> 0/� 0 <br /> 1!4/2023 � .� .=: <br /> Owner/Autho'ed Agent Signature Date (Revised 2/8/2021) <br />