2918 NASSAU ST 2025-08-14 - Laserfiche WebLink

E P ItMBING PERMIT APPLICAIN EVERETT SUBMITTAL CITY OF EVERETT PERMIT SERVICES INSTRUCTIONS:Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425.257.8810 I(E)everetteps@everettwa.gov I(W)everettwa.gov/permits (Blue.or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET VW ^/Ass 4 v s"'gee 7 PARCEL#: CITY V VV Re"?r STATE 104. ZIP fig t Q J SUITE/UNIT#: �/,30 7 f ij 4 FLOOR#: ADDITIONAL LOCATION INFORMATION: 1 TENANT/BUSINESS NAME(i/non-residential): CONTACT INFORMATION OWNER NAME: .Ali) V,/C ( W /IPA oar_C I-Lc_ g U AYf MO) OWNER MAILING ADDRESS: STREET ((f 3 /72 54 et L'6 N .r ` f ( are K j It g LA/tipSTATE A- ZIP 1g OWNER PHONE: 42.5 1 b — R 2 3 0 WA- EMAIL: s tjo yQ. S?E1i✓,g IG„j Lcc• 4.1, CONTRACTOR COMPANY NAME: r 4*R Pt IUM8r 4WA STATE CONTRACTOR LICENSE#(REQUIRED)1PahR pall, iiit OF EVERETT BUSINESS LICENSE#(REQUIRED ZO( CONTRACTOR ADDRESS: STREET /o4/Z y p.m A vd- ‘,/e- CITY V/�.e//��R Fri STATE fro oA ZIP lei S CONTRACTOR PHONE: 4 2 s 3 y 3 p(� CONTRACTOR EMAIL:3. PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) D. .C-del`(4 //IS W/WA R CONTACT NAME: YAW GJt CONTACT PHONE: 7 0•4 CONTACT EMAIL: PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ *oaf, O ("j ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fairalue of all labor,materials,and equipment nee ed to complete the work,whether actually paid or not.) P BUILDING TYPE: ESFR ❑Townhouse ❑Duplex ❑ADU ulti- ily-#Units: . ❑Commercial ❑Accessory Structure NION OF WORK: rCRIPT ,1 (J # �-- / -IA,AS N I�'R 1 ®K Ye g ett/AIBM ge6G�' I44 2d/) YitC k f 1 ,4L` , 704I it;4/ Rio y PLUMBING PERMIT FIXTURE COUNT(SCOPE OF WORK) 20,E!' ' 4� Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qty) Backflow Prevention Device(Inside Building)-select devices below: f Shower,Tub,or Combo Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) Clothes Washer W6 Residential Sink(kitchen,bath,bar) , Dishwasher Utility Sink(laundry,mop) Drinking Fountain 'j Toilet Floor Drain Urinal Hose Bibb Waste/Water Pipe Repair Ice Maker Water Service Line(Behind meter,private side) Grease Interceptor 2,7 Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump Other(List Type): 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 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 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, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only ll V ed 71. 2 209. 0 Owner/Autho Ag t Signature Date (Revised 2/8/2021)