2404 74TH ST SE 2024-06-13 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425.257.88101(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 7 ) 5;77 lj, PARCEL M CITY � —AO'/7 STATE lw� ZIP SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME: //'L EL S C � OWNER MAILING ADDRESS: STREET 1372 9/ /9IJG A4 CnY STATE ��/� 21P 7/ OWNER PHONE: 5 — 37 OWNER EMAIL: _T7_1-3,/,1.)J91(_(_V CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: LKOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Llo j 7?7 L L/em V e LA56 U CONTACT EMAIL: --t 7-6 t//113/Z-1- V vo L U J7 J PLUMBING PERMIT INFORMATION VALUATION OF WORK: $ �j(} U ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: LFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: A t z �G vm PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QIY) (Qty) Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA c7) Commercial Sink(3-compartment,prep,floor) Clothes Washer Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) U Drinking Fountain Ij Toilet /j Floor Drain Q Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker fL-3 Water Service Line(Behind meter,private side) Grease Interceptor (�> Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric C' Medical Gas Water Heater-Gas Roof Drains Other(List Type): 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 1 am authorized by the owner of this property to perforin 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 PERMIT#' ^ Owner/Authorized Agent Signature Date (Revised 218/2021)