Laserfiche WebLink
PLUMBING PERMIT APPLICATION <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 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 <br /> L�` j�S ) �� �f Z PARCEL#: <br /> cITY C— V �� STATE 1t)1q' ZIP <br /> SUITE/UNIT#: 3 Cj Meclt 900ty FLOOR#: ?j ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential): v,�1a� PC--(2- cool;: 7, 10 <br /> CONTACT INFORMATION <br /> OWNERNAME: I e,0 eL <br /> OWNER MAILING ADDRESS: STREET jI) _j(L ��p oe r <br /> CITY 'Sell P STATE l ZIP ! l <br /> OWNER PHONE: V0(O—&5V f,57fU -7— OWNER EMAIL: <br /> CONTRACTOR COMPANY NAME: �J�) r!L b L. 1 11 LLC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED): t;�(r(✓' '�O Nj C Y OF EVERETT BUSINESS LICENSE 1/(REQUIRE 3(0 7 <br /> CONTRACTOR ADDRESS: STREET C' 1 j' <br /> CITY STATE v/7 ��� ZIP <br /> CONTRACTOR PHONE: (,cU 3 — Lrl 9& CONTRACTOR EMAIL:h r.Tll �' <?'17rt1171/1911 , v <br /> PRIMARY CONTACT: W OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 6t � vty_ CONTACT PHONE: y,_�s <br /> CONTACT EMAIL: hoc-k a 1!"1 17 i lf�� <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $ /d Qa ASSOCIATED PERMIT# if applicable): &M5 —040 <br /> (Valuation shall include the prevailing fair ma et value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) <br /> BUILDING TYPE: ❑SFR ❑Townhouse ❑Du lex ❑ADU ulti-Family-#Units:_ ❑Commercial DAccessory Structure <br /> DESCRIPTION OF WORK: IIIS4X& MAO ;C 0kk1' 5- 3f k S <br /> �Vt CoftifpoK P-0001 'r lNS" G4f5kt"- <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qfy) (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 JL Toilet <br /> Floor Drain Urinal <br /> Hose Bibb WastefWater Pipe Repair t r• )5 <br /> Ice Maker Water Service Line(Behind meter,private side) cya w L"Ik <br /> Grease Interceptor Water Valves/Fixtures <br /> Sand/Oil Interceptor Water Heater-Electric <br /> Medical Gas lWater Heater-Gas <br /> Roof Drains 10ther List Type): <br /> Sewage Ejector Pump/Sump Pump I 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Alt' AZ <br /> PERMIT# ��to— bit <br /> Ow er/Authorized Age" Sign lure I D to F (Revised 412112022) <br />