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PLUMBING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PRA_IF[_T CITF IIJFnIMMATInIJ <br />PROJECT SITE ADDRESS. STREET 10521 19th Ave SE PARCEL 28052000203000 <br />clTv Everett STATE WA zIP 98208 <br />SUITE/UNIT #: 101 FLOOR #: ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): Edward Jones <br />CONTACT INFORMATION <br />OWNER NAME: lawrence Group <br />OWNER MAILING ADDRESS: STREET 319 North 4th Street - Ste 1000 <br />clTv St. Louis STATE MO zIP 63102 <br />OWNER PHONE: 314-392-2732 <br />OWNER EMAIL: jason.miles@cushwake.com <br />CONTRACTOR COMPANY NAME: GS Mechanical LLC <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): GSMECML795RW <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 047137 <br />CONTRACTOR ADDRESS: STREET PO Box 65 <br />clTv Redmond STATE WA zIP 98073 <br />CONTRACTOR PHONE: 206-372-0332 <br />CONTRACTOR EMAIL: greg@gsmechanicalshop.com <br />PRIMARY CONTACT: ❑ OWNER ✓❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Greg Smalling <br />CONTACT PHONE: 206-372-0332 <br />CONTACT EMAIL: greg@gsmechanicalshop.com <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 8000 ASSOCIATED PERMIT It (if applicable): <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 ❑Multi -Family - # Units: ✓❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: Replace existing domestic gas fired water heater with new AO Smith ENT-50 electric. <br />PLUMBING PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA <br />Shower, Tub, or Combo <br />Commercial Sink (3-compartment, prep, floor) <br />Clothes Washer <br />I <br />lResidential Sink (kitchen, bath, bar) <br />Dishwasher <br />t <br />Utility Sink (laundry, mop) <br />Drinking Fountain <br />Toilet <br />Floor Drain <br />Urinal <br />Hose Bibb <br />Waste/Water Pipe Repair <br />Ice Maker <br />Water Service Line (Behind meter, private side) <br />Grease Interceptor <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />t <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />Other (List Type): <br />Sewage Ejector Pump/Sump Pump <br />10ther (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. I 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 />PERMIT # <br />7.18.24 I I <br />Owner/Authorized Agent Signature Date (Revised 412112022) <br />