Laserfiche WebLink
1 <br /> PLUMBING PERMIT APPLICATION <br /> EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES <br /> INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET (Q-lc St.) PARCEL#: Z$()(-( 3 '(oc 3c t <br /> CITY STATE vJ A ZIP Cj Z'<]7 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> 1 CONTACT INFORMATION <br /> OWNER NAME: }c�v-,K Cc.,s6, .. C 04, y <br /> OWNER MAILING ADDRESS: STREET G <br /> cm (j(A0,, sue,((L STATE LAjP ( ZIP qc8Z 7 c <br /> OWNER PHONE: tj LS cr7 to 5J( OWNER EMAIL:,3u5(ccx Cw p;.\-1 CC> \str �6.A,(Q.) s{,(14 CA,s 1.0.e& <br /> CONTRACTOR COMPANY NAME: r-A C_Lt c 41,N (o.%5 u•-1.s �. <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED) 5-T4CC 9 ('(, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): S �j 33 6 <br /> CONTRACTOR ADDRESS: STREET "P, x <br /> CITY M0.161.I1((. STATE W'\ ZIP IO 7_-70 <br /> CONTRACTOR PHONE: `I 25 S_y j (t,Srj( CONTRACTOR EMAIL: �1� >f �� � Co.�S�vc.�k�cy c, VVut •c cu <br /> PRIMARY CONTACT: ZOWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: s 7 (fl 51, <br /> CONTACT EMAIL: ( 1 ( l <br /> '�""� V��r� t�.�S�c�•-� c�-s�1�v� cc) t'YIGr '��c1r.'t, <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $ ASSOCIATED PERMIT#(if applicable): A/C l-•i 80(I .4i0 to <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 EMulti-Family-#Units: ❑Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK: <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (city) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: 3 Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:IZRPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer 5— Residential Sink(kitchen,bath,bar) <br /> Dishwasher Utility Sink(laundry,mop) <br /> Drinking Fountain 3 Toilet <br /> Floor Drain Urinal <br /> OA Hose Bibb / Waste/Water Pipe Repair <br /> I Ice Maker / Water Service Line(Behind meter,private side) <br /> t Grease Interceptor /6 Water Valves/Fixtures <br /> Sand/Oil Interceptor Water Heater-Electric <br /> Medical Gas / Water Heater-Gas <br /> Roof Drains Other(List Type): <br /> Sewage Ejector Pump/Sump Pump Other(List Type): <br /> 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 <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.f am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> —7 PERMIT# Z 1 i Z_0 <br /> �c.titCALUP-- ) /- —,2U/ <br /> Owner/Authorizent Signatur Date (Revised 2/8/2021) <br />