1038 WOODLAWN AVE B 2025-12-01 - 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 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT§ITE INFORMATION PROJECT SITE ADDRESS: STREET K PARCEL#: CiTY STATE W ZIP / SUITE/UNIT#: FLOOR M ADDITIONAL LOCATION INFORMATION: TENANURUSINES ME(if non-residential): CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CiTY is STATE ZIP OWNER PHONE: 5 OWNER EMAIL: C ( CONTRACTOR COMPANY NAME: (J WA STATE CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: WOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: PLUMBING PERMIT INFORMATION 00 VALUATION OF WORK:$ 6 S 0 ASSOCIATED PERMIT#(if applicable): (Valuation shall include the prevaBIng fair market value of all labor,materials,and equipment needed to complete the work,Whether actually paid or not.) BUILDING TYPE: ❑SFR []Townhouse p6uplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure DESCRIPTION OF WORK: L;W11-//- A-,L� LaL PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Fixture Count fist of Fixtures Count List of Fixtures n (Qty) (Qty) �1 Backflow Prevention Device(Inside Building)-select devices below: Shower,Tub,or Combo Fire Service:❑DCDA, Domestic Service:❑RPBA❑DCVA Commercial Sink(3-compartment,p oor) Clothes Washer Residential Sink(kitchen,bath,bar) 1111 Dishwasher Utility Sink(laundry,mop) Drinking Fountain Toilet CITY OF EVEE L- 1 Floor Drain Urinal perrnit services 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: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 I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Con actors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# n ��1 iLC `I4/ Il yO G{I- Owner/Authorized A e T naEUre ate (Revised 4/21/2022)