2505 MADISON ST 2025-09-26 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION EVERETT SUBMITTAL INSTRUCTIONS: OF EVERETT PERMIT SERVICES S: 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)PermitServices@everettwa.gov i(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: .TR.ET 2505 Madison Street PARCEL#: 00544701300800 Crry Everett STATE WA ZIP 98203 SUITE/UNIT#: FLOOR#: Basement ADDITIONAL LOCATION INFORMATION: Upstairs Living room TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME:Jasmine Crews OWNER MAILING ADDRESS: sTREET2505 Madison Street CITY Everett STATE WA zip 98203 OWNER PHONE:425-319-8317 IOWNER EMAIL:jasmine_crews@yahoo.com CONTRACTOR COMPANY NAME:OWNER WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: R1 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-319-8317 Jasmine Crews CONTACT EMAIL:jasmine_crews@yahoo.com PLUMBING PERMIT INFORMATION VALUATION OF WORK:$10,000 C l 7 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair market value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ❑✓Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK:installing drain and 2 supply lines downstairs and installing overflow drain and 4 supply lines upstairs PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qty) Backflow Prevention Device(Inside Building)-select devices below. Shower,Tub,or Combo Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,prep,floor) I Clothes Washer t Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain Toilet Floor Drain Urinal Hose Bibb 2 Waste/Water Pipe Repair Ice Maker Water Service Line(Behind meter,private side) Grease Interceptor Water Valves/Fixtures Sand/Oil Interceptor 1 Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector PumplSump Pump I Other(List Type): ACKNOWLEDGEMENT.-/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 l am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Own uthorized Agent Signature Date (Revised 412112022) I