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t V t K SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASH 1 N G TON 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 1920 Monroe Ave PARCEL #: 00545002801100 <br /> crry 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: Christopher Cocking <br /> OWNER MAILING ADDRESS: STREET 1920 Monroe Ave <br /> rrTY Everett STATE WA zrP 98203 <br /> OWNER PHONE:425-446-1910 OWNER �9 <br /> EMML: ChriS.COCkin wa mail .Com <br /> 9 <br /> CONTRACTOR COMPANY NAMERROPERTY OWNER <br /> WA STATE CONTRACTOR LICENSE #(REQUIRED): PROPERTY OWNER CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): PROPERTY OWNER <br /> CONTRACTOR ADDRESS: STREET 1920 Monroe Ave <br /> CITY Everett STATE WA ZIP 98203 <br /> CONTRACTOR PHONE:425-446-1910 �9wa CONTRACTOR EMAIL: Chris.cockin9 mail .com <br /> PRIMARY CONTACT: ❑✓ OWNER ❑ CONTRACTOR C OTHER (Please Specify) <br /> CONTACT NAME: Christopher CockingCONTACT PHONE:425-446- 1910 <br /> CONTACT EMAI <br /> L: chrls.cockingwa@gmall.com <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $0.00 ]ASSOCIATED PERMIT # if applicable : NONE <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 EADU ❑Multi-Family - # Units: ❑Commercial DAccessory Structure <br /> DESCRIPTION OF WORK: Remove and replace exist in p t g drains and water pipes with new ones <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Q <br /> OBackfiow Prevention Device (Inside Building) -selectdevices below. 1 Shower, Tub, or Combo <br /> Fire Service- ❑DCDA_ M-imAn in Service- t IRPRA �DCVA n Comrnorcial Sink 3-comportmont, prop, rlVVQ <br /> Clothes Washer 2 Residential Sink (kitchen, bath, bar) <br /> t Dishwasher o Utility Sink (laundry, mop) <br /> o Drinking Fountain I Toilet <br /> o Floor Drain o Urinal <br /> 2 Hose Bibb o Waste/Water Pipe Repair <br /> I Ice Maker o Water Service Line (Behind meter, private side) <br /> o Grease Interceptor 8 Water Valves/Fixtures <br /> o Sand/Oil Interceptor I Water Heater - Electric <br /> o Medical Gas o Water Heater - Gas <br /> o Roof Drains Other (List Type): <br /> o 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 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 Off dal Use Only <br /> PERMIT # <br /> Owner/Authorized Agent Signature D�_itc, (Revised 412112022) <br />