902 110TH PL SE 2024-06-14 - Laserfiche WebLink

• PLUMBING PERMIT APPLICATION 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)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black lnk Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 1 d2 \\ h P L S 6 PARCEL#: /3 (2' c) F 003 EV P CITY _ STATE ./ ZIP el 2 SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: 5 5:17,„,e too I ( A-14 lilrR L Yl/1 ��it 'I �Ll !`T�e OWNER MAILING ADDRESS: STREET cd j/p f7/ se_ e_V e& e)re--1,,,1 CITY STATE eV-A-- ZIP Pg ------ OWNER PHONE: ��6 _—'� & OWNER EMAIL: 4-1yt-gl ej, 501 ;f CONTRACTOR COMPANY NAME: 11(Ar) 11 WA STATE CONTRACTOR LICENSE#(REQUIRED): /1` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET /A-- CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ 3�jjj��-- ASSOCIATED PERMIT#(if applicable): O 7 — a®3 (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actual) aid or not.) BUILDING TYPE:3SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ` ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: pe /Com 14 OF 4-/aShercaeller- ea PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QMy) (Qty) Backflow Prevention Device(Inside Building)-select devices below: Cj 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 0 Utility Sink(laundry,mop) 0 Drinking Fountain - Toilet 0. Floor Drain G Urinal G Hose Bibb A Waste/Water Pipe Repair op *Maker �y•, Water Service Line(Behind meter,private side) Grease Interceptor 3.-Water Valves/Fixtures 0 Sand/Oil Interceptor D Water Heater-Electric p Medical Gas 8 Water Heater-Gas Roof Drains c.2 Other(List Type): G Sewage Ejector Pump/Sump Pump Other(List Type): 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 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 l 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 (I 7 z-z PERMIT# p2;2_ u-A Owner/Authorized Agent Signature Date (Revised 2/8/2021)