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on <br /> 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 /> WASHINGTOS CONTACT INFORMATION: (P)425-257-8810 i (E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <br /> t..-k4 CRESCENT AVE (lot 3) PARCEL#: 00605501500600 <br /> CITY <br /> EVERETT :Tir.TE WA p 98203 <br /> SUITE/UNIT#: FLOOR#: ADDITIONAL LOCATION INFORMATION. <br /> TENANT/BUSINESS NAME(if non-residential): <br /> CONTACT INFORMATION <br /> OWNER NAME:AMA VENTURES LLC <br /> OWNER MAILING ADDRESS: STREET PO BOX 271 <br /> CIT' LAKE STEVENS STATE W ZIP 98258 <br /> OWNER PHONE:4255082465 OWNER EMAIL:pavelgpa a@g ail.com <br /> CONTRACTOR COMPANY NAME: GPA ENTERPRISES INC <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):GPAENEI853D5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 62284 <br /> CONTRACTOR ADDRESS: STREET PO BOX 271 <br /> CI r, LAKE STEVENS 5 -E WA ,,,, 98258 <br /> CONTRACTOR PHONE:4255082465 CONTRACTOR EMAIL:PaveigPa@gmail.com <br /> PRIMARY CONTACT: El OWNER 71 CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK:$ 1`1 L '—' ASSOCIATED PERMIT#(if applicable):RB2307-001 <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 /> 'Multi-Family #Units: ❑Commercial rAccessory Structure <br /> BUILDING TYPE: ✓OSFR Townhouse I�Duplex JADU y- <br /> DESCRIPTION OF WORK: <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> PLY) ' (Qty) <br /> Backflow Prevention Device(Inside Building)-selerd devices below. .. Shower Tub.or Combo <br /> Fire Service JDCDA Domestic Service. ._JRPBA❑DCVA Commercial Sink(3-compartment,prep,floor) <br /> 1 Clothes Washer y- Residential Sink(kitchen.bath. bar) <br /> ( Dishwasher Utility Sink(laundry.mop) <br /> Drinking Fountain Toilet L / ����, <br /> Floor Drain �' Urinal L <br /> Hose Bibb1 1/ <br /> W Waste ater Pipe Repair <br /> Ice Maker 1 Water Service Line(Behind er, riAvAatne id <br /> Grease Interceptor Water Valves/Fixtures p I•IMH I 4 Z04 141) <br /> Sand/Oil Interceptor Water Heater-Electric <br /> Medical Gas Water Heater-Gas CITY OF EVERETT <br /> Roof Drains Other(List Type) <br /> ti <br /> Sewage Ejector Pump/Sump Pump - Other(List Type) I t lit Sti ViceS <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 ern 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 ith he State Contractors Law 18.27 ROW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> ,_----- PV IT <br /> Owner/Authorized Agent Signature ate (Revised / 1/2 2) <br />