2204 GRAND AVE 2024-07-01 - 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 j(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET ZzO E, AVE PARCEL#: p i c" E3 Cr -T—T STATE W/^� ZIP p Z O 1 SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): / CONTACT INFORMATION OWNER NAME: -�L0 171 LLL, Q OWNER MAILING ADDRESS: STREET Q ,gja m94 CITY W o op l VIE STATE \VV ZIP 7 OWNER PHONE: '\5, p OWNER EMAIL: IS rnCt t�•5.12 LiQ.LavN CONTRACTOR COMPANY NAME: 10 W CIL WA STATE CONTRACTOR LICENSE#(REQUIRED):O W N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: 14OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: PLUMBING PERMIT INFORMATION VALUATION OF WORK:$1500 1 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: MSFR ❑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) (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) Clothes Washer Residential Sink(kitchen,bath,bar) Dishwasher Utility Sink(laundry,mop) Drinking Fountain Toilet Floor Drain Urinal Hose Bibb Waste/Water 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 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 authorize�djr any circumstance.I am Ilia owner,or I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractor L w 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 4041 rx� PERMIT# /, 3^ !� 4f-�V� 1 0 I Owner/Authori Ag t Signature Date (Revised 4/21/2022)