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PLUMBING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <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 & C A 5 d N U PARCEL M <br />CITY F v rr f f STATE (.'(-- >/i ZIP <br />C, d O <br />SUITE/UNIT M FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): ,L,OS <br />CONTACT INFORMATION <br />OWNER NAME: N & J <br />P <br />�/ n <br />OWNER MAILING ADDRESS: STREET y0 `3 F `� <br />CITY 7 Cl'_ tL I /_ 4 f1 U STATE (,�s Q , ZIP <br />47 © U <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR COMPANY NAME: ), 03 L LC Ff' I t CtZ ew!4 IU f' L <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CIITnTY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />CONTRACTOR ADDRESS: STREET 0 -+ W- C A 51" t2l) '— 3 t t Q r <br />CITY y�/Er�✓ L'r f STATE ' ZIP <br />�a DO <br />CONTRACTOR PHONE: (3 60) 3 t- (c� t <br />CONTRACTOR EMAIL: <br />/� <br />Ea two d h ry N 2ej d¢ Z <br />ff I. L J c C OM <br />PRIMARY CONTACT: ❑ OWNER (_CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Eb PE- f llf � �lj i�+F Z <br />L t ,-� <br />CONTACT PHONE:O60 [ .3 1 <br />CONTACT EMAIL: It 1 d 61 it Y P tt ,�'� � L �� <br />/� <br />� i �I c ` <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ Ci�� r� ASSOCIATED PERMIT # (if applicable): t a3o e; - U 3 <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 []Townhouse []Duplex ❑ADU ❑Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: <br />� N •VAC-L GO � Cv.LOArM/ fal- CtuIK- a,-Jd <br />V-• _ Post Al r x•�. t� ''t- CVoy- Clr�lG C'lNdc� i G' <br />PLUMBING PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <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 />- t> rJ , <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 />WastefWater 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 - Eleclric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />Other (List Type): 1 ft,f IA--A't <br />Sewage Ejector Pump/Sump Pump <br />Other (List Type): u-1 Ic- <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 Law 18.27 RCW and 296.200A WAC. <br />Owner/Authori4bd Agent Signature <br />. 06- ,D) -) <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 412112022) <br />