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`i PLUMBING PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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. <br /> WASHINGTON CONTACT INFORMATION: (P)425-257-8810 i(E)PermitServices@everettwa.gov i(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 535 View Ridge Dr PARCEL#: 004647 000 062 01 <br /> clTy Everett STATE WA zip 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:J & S Development LLC <br /> OWNER MAILING ADDRESS: sTREET 22621 57th Ave SE <br /> CITY Bothell STATE WA zip 98021 <br /> OWNER PHONE:425-870-8922 OWNER EMAIL:bstrootman@msn.com <br /> CONTRACTOR COMPANY NAME:Robinson Plumbing Inc <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):ROBINP179607 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)J 8098 <br /> CONTRACTOR ADDRESS: STREET 1230 121 st Place SE <br /> clTy Everett STATE WA zip 98208 <br /> CONTRACTOR PHONE: 425-508-3459 CONTRACTOR EMAIL:robinsonplumbinginc@gmail.com <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) CivilEng-ProjectPM <br /> CONTACT NAME: CONTACT PHONE: 425-773-9567 <br /> Bob Nehring, PE Sound Design Eng CONTACT EMAIL: bob.sdeng@gmail.com <br /> PLUMBING PERMIT INFORMATION <br /> 34,000 ASSOCIATED PERMIT# if applicable): <br /> VALUATION OF WORK: $ ( pp ): <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: ZSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ElAccessory Structure <br /> DESCRIPTION OF WORK: <br /> Complete plumbing for SFR model 4335 <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qiy) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: 5 Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer a Residential Sink(kitchen,bath,bar) <br /> t IDIshwasher I Utility Sink(laundry,mop) <br /> Drinking Fountain 5 Toilet <br /> Floor Drain Urinal <br /> 2 Hose Bibb Waste/Water Pipe Repair <br /> 1 Ice Maker 1 Water Service Line(Behind meter,private side) <br /> Grease Interceptor Water Valves/Fixtures <br /> Sand/Oil Interceptor 1 Water Heater-Electric <br /> Medical Gas Water Heater-Gas <br /> 4 Roof Drains Other(List Type): <br /> Sewage Ejector Pump/Sump Pump Other(List Type): <br /> ACKNOWLEDGEMENT:l 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. /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 /> km , ,P ( � 6/26/23 PERMIT#1 <br /> t V <br /> Owner/Au orized Agent Signature Date (Revised 412112022) <br />