2410 EVERETT AVE 2024-02-20 - Laserfiche WebLink

mg PLUWING PERMIT APPLICATI CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425-257-8810 I(E)PermitServices@everettwa.gov J(W)everettwa.gov/permits _ .. (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET „Z/I b e I/.,(4v.. 1y ✓v PARCEL#: CITY ( Vey e // STATE 1/16ef ZIP 7!go/ SUITEIUNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: J,p lift S I2?J C] 1 pt.pt. @ V( lit, C D h OWNER MAILING ADDRESS: STREET / a.3 1 Co l '/�/'y Al.. CITY e.,✓ STATE ZIP OWNER PHONE: ('p- 3-7 0 - OM OWNER EMAIL: l/,t 7 Vj 4.(I7 ACa h IQ y Ji 12D , e44,kii CONTRACTOR COMPANY NAME: J—OV 11 C I/( q, C bkl — 6 4 N (!k WA STATE CONTRACTOR LICENSE#(REQUIRED): iv 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Nit h CONTRACTOR ADDRESS: STREET )�3/ r2),/ 4-vi CITY ke 'L STATE WA ZIP '2 a-U I CONTRACTOR PHONE: 210' W y a-- 01 35 CONTRACTOR EMAIL: ... b Y C L to L� D�a /1/A Pi) . C.4 W i PRIMARY CONTACT: rgOWNER 0 CONTRACTOR 0 OTHER(Please Specify) ` 1 CONTA T NAME: D CONTACT PHONE: 2_0 V- -3 -7 D - 0 0 I/ '" 1/(� C a W i CONTACT EMAIL: r r 0 u a Lt C IA ? ` Gl, i'l 06 - CC yi/L PL►MBING PERMIT INFORMAtION VALUATION OF WORL.,,,,,,....,0O . C)v ASSOCIATED PERMIT#(if applicable): 13 2-3 0 3 -1) 2 I)(Valuation shall indude the pt value of at Ia••, aterials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: e ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DE CRIPTION OF WORK: _ 1 -f c i 1 �J k1 VUJ �tpJ f1YS, h �r ��eo , �t LP i-j )141--rit-LI r) tit *,/cA.1,4 4 7 ' pl. h-cor-r__i 4 i i_ Kt PLUMBING PE IT FIXTURE COUNT(SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (Qtw) Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service:❑DCDA, Domestic Service:❑RPBA DDCVA Commercial Sink(3-compartment,prep,floor) 1' Clothes Washer Residential Sink(kitchen,bath,bar) Dishwasher 1 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(Ust 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.lam 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 State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ./--- n / t 9-� �� PERM S ' ,LitV nerlAutho Agent Signature Date (RevisedS --44/21/2022)