2623 GRAND AVE 2025-09-30 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 2623 U rand Ave PARCEL M CITY Everett STATE WA ZIP 98201 SUITE/UNIT M B FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME:2623 Grand Ave LLC OWNER MAILING ADDRESS: STREET PO Box 1094 CITY Woodinville STATE WA zip 98072 OWNER PHONE-425.244.0007 OWNER EMAIL:ISmall.seattle@gmail.com CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): . CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET ��G CITY .. .... , STATE _ ZIP CONTRACTOR PHONE:9C 2 CONTRACTOR EMAIL: ' PRIMARY CONTACT: ❑✓ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425.244.0007 Ismail Mohammad CONTACT EMAIL:ISmaII.Seattle@gmail.com PLUMBING PERMIT INFORMATION VALUATION OF WORK:$2,500 1ASSOCIATED PERMIT#(if applicable): B2312-027 (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: Converting SFR to Duplex by Adding Bathroom and Kitchen PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qty) (Qfy) 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) Clothes Washer L Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain Toilet Floor Drain Urinal Hose Bibb WastefWater Pipe Repair Ice Maker Water Service Line(Behind meter,private side) Grease Interceptor Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump I 10ther(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 1 am authorized by the owner of this property to perform the work for which application Is made, and 1 comply with the Slate Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Ca� B� 3/5/24 PERMIT# P2.903- C913 Owner/Authorized Agent Signature Date (Revised 412112022)