6524 HIGHLAND DR 2024-12-09 - 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)PerinitServices@everettwa.gov I(W)everettwa.gov/perinits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET 6524 Highland Dr PARCEL#: 00531700400200 clTy Everett STATE WA ziP 98203 SUITEIUNIT#: A FLOOR#: ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME(if non-residential): CONTACT INFORMATION OWNER NAME:Eric Arneson OWNER MAILING ADDRESS: STREET 1 004 Commercial Ave, PMB 2074 c" Anacortes STATE WA ZIP 98221 OWNER PHONE:206-940-6562 1OWNER EMAIL:eharneSOn@gmail.com CONTRACTOR COMPANY NAME: WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICE f;# •a CONTRACTOR ADDRESS: STREET �. S CITY STATE zIP CONTRACTOR PHONE: CONTRACTOR EMAIL: F+UU PRIMARY CONTACT: ✓❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CITY OF EVERETT CONTACT NAME: CONTACT PHONE:206-940-6562 Pern-lit Services Eric Arneson CONTACT EMAIL:eharneson@gmail.com PLUMBING PERMIT INFORMATION VALUATION OF WORK: $ L)D ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevailing fair Ptiarket value of all labor,materials,and equipment needed to complete the work,whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse ZDuplex ❑ADU ❑Multi-Family-#Units: 1 ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: Hot water Tank Permit PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count List of Fixtures Count List of Fixtures (Qiy) (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 t Water Heater-Electric Medical Gas Water Heater-Gas Roof Drains Other(List Type): Sewage Ejector Pump/Sump Pump I Other(List Type): ACKNOWLEDGEMENT:l 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./am the owner,or/am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only 1 PERMIT# C, z Z O er/Authorized Agent Signature Date (Revised 412112022)