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PLUMBING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everetlwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: sTR,, 8417 Evergreen Way PARCEL #: 28041300104900 <br />❑Ty Everett STATE WA DP 98208 <br />SUITEIUNIT #: 3 FLOOR #: 1 ADDITIONAL LOCATION INFORMATION: <br />TENANT/BUSINESS NAME (if non-residential): MOchinut <br />CONTACT INFORMATION <br />OWNER NAME: Thomas Nguyen, Anh Nguyen <br />OWNER MAILING ADDRESS: STREEr8417 Evergreen Way <br />CITY Everett STATE WA zip 98208 <br />OWNER PHONE: 210.759.8881; 206.465.3208 <br />1OWNER EMAIL:thomasn73@gmall.com, tinahuonganh@yahoo.com <br />CONTRACTOR COMPANY NAME: Steve's Plumbing <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): STEVE P L791 MA <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 66493 <br />CONTRACTOR ADDRESS: STREET 1123 10TH ST APT 13 <br />CITY MARYSVILLE STATE WA SIR 98270 <br />CONTRACTOR PHONE:425.451.2464 <br />1CONTRACTOR EMAIL: vannylee6l O@gmall.COm <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ✓❑ OTHER (Please Specify) DESIGNERS <br />CONTACT NAME: NOS NA R I N <br />CONTACT PHONE: 206.322.4323 <br />CONTACT EMAIL: PERM IT@CATCHSTUDIO.COM <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $30,000 ASSOCIATED PERMIT # (if applicable): B2309-071 <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 ❑Du lex ❑ADU ❑Multi -Family- # Units: ✓❑Commercial ElAccessory Structure <br />DESCRIPTION OF WORK: Furnish and install plumbing fixtures and associated components per plan. Furnish and install new domestic water <br />piping system with all other associated components per plan. Furnish and install newwaste, grease waste and vent <br />system with all other associated components per plan. Install new electric 50 gallon water heater <br />PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />2 <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service: ❑✓ RPBA ❑DCVA <br />o <br />Shower, Tub, or Combo <br />4 <br />Commercial Sink (3-compartment, prep, floor) <br />o <br />Clothes Washer <br />o <br />Residential Sink (kitchen, bath, bar) <br />1 <br />Dishwasher <br />1 <br />Utility Sink (laundry, mop) <br />o <br />Drinking Fountain <br />2 <br />Toilet <br />2 <br />Floor Drain <br />o <br />JUrinal <br />o <br />Hose Bibb <br />o <br />Waste/Water Pipe Repair <br />1 <br />Ice Maker <br />2 <br />Water Service Line (Behind meter, private side) <br />1 <br />Grease Interceptor <br />o <br />Water Valves/Fixtures <br />o <br />Sand/Oil Interceptor <br />1 <br />Water Heater- Electric <br />o <br />Medical Gas <br />o <br />Water Heater- Gas <br />o <br />Roof Drains <br />8 <br />Other (List Type): eoorsinks and lavatories <br />o <br />Sewage Ejector Pump/Sump Pump <br />Other (List Type): <br />ACKNOWLEDGEMENT/ 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. 1 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 Official Use Only <br />4461d, ii%rt 1 /5/2024 PERMI T # <br />Owner/Authorized Agent Signature Date (Revised 4121/2022) <br />