3303 WAVE DR 2024-04-12 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES E V E R E T T 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 1(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3 () D PARCEL#: �3 V119ctTY (� re t f STATE it/ zip SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): / CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET (� C Q l h �(9, t% CITY ej (� (� f STATE ✓V ZIP ,ys Q OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: d I n Ci WA STATE CONTRACTOR LICENSE#(REQUIRED):f'j j R M L4OF EVERETT BUSINESS LICENSE#(REQUIRED): e LC t t�3 CONTRACTOR ADDRESS: STREET b I ✓ Lt YL (,rr*1 d P r �/� CITY V STATE W zip p Z,0_3 CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ 0 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevaaing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (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) 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): J h awG/ 1)awn 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.I 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 t tate Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# e2,30 1- 0 �3 Owner/Autltori ed Agent Signature Date (Revised 2/8/2021)