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DocuSign Envelope ID: 1 D3713F6-161 F-48A5-AF49-D25240655966 <br /> PLUMBING PERMIT APPLICATION <br /> EVERETT SUBMITTAL INSTRUCTIONS: <br /> OF EVERETT PERMIT SERVICES <br /> S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 920 Wetmore Ave PARCEL#: 00385417602400 <br /> CITY Everett STATE Wa zip 982001 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:Chester L Beard III <br /> OWNER MAILING ADDRESS: sTREETPO BOX 1508 <br /> CITY Langley STATE Wa zip 982600 <br /> OWNER PHONE:425-218-5567 1OWNER EMAIL:chester.beardiii@gmail.com <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: 0 OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: -DDS $�z�z�22 CONTACT PHONE:425-21 8-5567 <br /> Chester L Beard lULI CONTACT EMAIL:chester.beard lll iii@gmail.com <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $1 8,0000 1ASSOCIATED PERMIT#(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: EISFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> DESCRIPTION OF WORK:Repipe following fire damage to house. Move bathroom to back of house and install <br /> new sink and dishwasher in kitchen area. New washer dryer in bathroom area. One <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> 1 Backflow Prevention Device(Inside Building)-select devices below: 1 Shower,Tub,or Combo <br /> Fire Service: ❑DCDA, Domestic Service: ❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> 1 Clothes Washer 2 Residential Sink(kitchen,bath,bar) <br /> 1 Dishwasher Utility Sink(laundry,mop) <br /> Drinking Fountain 1 Toilet <br /> Floor Drain Urinal <br /> 2 Hose Bibb Waste/Water Pipe Repair <br /> 1 Ice Maker 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 /> Roof Drains Other(List Type): <br /> Sewage Ejector Pump/Sump Pump 1 1 Other(List Type): <br /> ACKNOWLEDGEMENT:/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.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> F��Signed by: <br /> L _ 8/2/2022 PERMIT# <br /> Owner u orize gent Signature Date (Revised 412112022) <br />