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PLUMBING PERMIT APPLICA In TI.ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 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)everetteps@everettwa.gov I(W)everettwa.gov/permits <br /> (B.lue.or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET <br /> �r� (' y�>� e 'pa L(// S( PARCEL#: <br /> CITY % ( STATE ZIP t;203 <br /> SUITE/UNIT#: FLOOR#: J ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): <br /> �r <br /> CONTACT, INFORMATION <br /> OWNER NAME: it)%17 <br /> l nJ --I' a7,4ya€ iT <br /> OWNER MAILING ADDRESS: STREET /S---- /e /(j ,] (�(4 ,_S <br /> CITY (! UV✓ I STATE /� ZIP £(8z4 3 <br /> OWNER PHONE: -c-Z( (PO (p9 7 OWNER EMAIL: LiIOaiWM-3 Zitt lws�-WIa (-GOvv <br /> CONTRACTOR COMPANY NAME: S1 1A <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): 56-7,-P. CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `] f <br /> CONTRACTOR ADDRESS: STREET ,ll pML" 04,11M <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: S too 10 GI7 CONTRACTOR EMAIL: /pr'aVjiel 32 (•(Ov'✓t <br /> PRIMARY CONTACTWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: NA, <br /> a <br /> CONTACT EMAIL: AA-- <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK:$ .i)2,000 ASSOCIATED PERMIT#(if applicable): /t/ <br /> (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid o�r not.) <br /> BUILDING TYPE: SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> DESCRIPTION O WORK: <br /> 490'4 ---(6)/0,0 AtpuzAviii --v 6----xt.swbi liAb/2- i'14,97J Csowz 7 vit,,,--77-7,-,6) <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: / Shower,Tub,or Combo <br /> Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> Clothes Washer / Residential Sink(kitchen,bath,bar) <br /> Dishwasher Utility Sink(laundry,mop) <br /> Drinking Fountain / Toilet <br /> Floor Drain Urinal <br /> Hose Bibb Waste/Water Pipe Repair <br /> Ice Maker Water Service Line(Behind meter,private side) <br /> Grease Interceptor 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:1 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# ///j 2 G I _ 0 <br /> 3 <br /> 0 uthonze g nat Date (Revised 2/8/2021) <br />