3630 LOMBARD AVE A 2025-12-12 - 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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 3�,1,L7 �, AVE PARCEL#: ` c� CITY i5VL-RC—TT STATE �/'1 21P d SUITE/UNIT M FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): �eX{{C�{� = T( C t0� CONTACT INFORMATION OWNER NAME: Tti I e A OWNER MAILING ADDRESS: STREET �pM�3�}�2Q A VE CITY V STATE ZIP 70 OWNER PHONE: - U OWNER EMAIL: ??_C_XHE-0 ffep— l�"� {{pT-/q t j CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 67,,ri CONTACT EMAIL: T6X_Ht 'T I'C,'} e�1407"A;Z-,--00 PLUMBING PERMIT INFORMATION VALUATION OF WORK:$ QQ� Uo 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: PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (QtY) (QIY) Backllow 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 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 1. Water Valves/Fixtures Sand/Oil Interceptor Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): C- i 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.D atlons must first be authorized in writing from th Building Official before being authorized under any circumstance./am the owner,or/am authorized by the owner of this prope o perform the work for which applica s made, and I comply wi a ontractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# T5� �� 6 2oZS � -`U JU Owner/Aut ri Age t Signature D to (Revised 412112022)