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Home My WebLink About3319 176TH PL NE_BLD1011_2026 RESIDENTIAL PLUMBING PERMIT APPLICATION Department of Community& Economic Development City of Arlington• 18204 59th Ave NE •Arlington,WA 98223 • Phone(360)403-3551 THIS APPLICATION IS TO BE USED WHEN APPLYING FOR NEW PLUMBING INSTALLATION FOR EXISTING RESIDENCES. PLEASE FILL OUT ALL PAGES OF THIS APPLICATION AND INCLUDE ALL INFORMATION. Project Address: ��, ` �r . �� 1✓ �' �G'I �1 �$ �,� Project Description: �,Ve, nA Owner: �0� Address: �Glq 1 7V'�- City: PCIi,1464State: Si Zip Code: Phone: Email: Applicant: o)u q5 �4 I�q .`c of Address: City: State: Zip Code: Phone: Email: �1 � CONTRACTOi I R INFORMATION Contractor Name: 'V �VS6 1U�+�aq Address: j�,1 �� C� City: k 11 kdA State:W Zip Code: License Number:*�W 5 Expiration: �--Io— is �Co Phone: � � � Email: 6 01Q6� 4""''!_. J STAFF USE ONLY Received Permit#: Accepted by: Date MAY 10 2016 RESIDENTIAL PLUMBING PERMIT APPLICATION _ Department of Community& Economic Development City of Arlington• 18204 59th Ave NE • Arlington,WA 98223 • Phone(360)403-3551 Plumbing Section (check all that apply) (Check all that apply and indicate the number of fixtures proposed) ll ❑ Bath/Shower Combo (4.0) x [] Sink (1.5) x l ❑ Shower(2.0) x ❑ Lavatory(1.0) x I ❑ Clothes Washer(4.0) x l Water Closet(2.5) x l ❑' Dishwasher(1.5) x l ❑ Water Heater x ❑ Hose Bibb(2.5) x ❑ Other(list) Proposed Water Piping Size: Proposed Piping Material: 7E y/ Proposed DWV Material: i9�55 Proposed DWV Size: • All hose bibs required to be equipped with Atmospheric Vacuum Breakers per ASSE 1019 • All water supplies at 80psi or greater shall have Pressure Reducing Valves (PRV) • Cross-Connection-Control may be required Applicant Signature: Date: 16 I hereby certify that the above information is correct and that the construction, installation for the above mentioned property will be in accordance with the applicable laws of the City of Arlington and the State of Washington. CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON, VISA.98223 PHONE; (360)403-3551 BUILDING PERMIT Address:3319176th PI NE Permit#:1011 Parcel#:00621300009300 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:BOSLEY DONNA SUE Name:NW Custom Plumbing Name:NW Custom Plumbing LLC Address:3319 176TII PL NE Address:18821 I Ith Ave NE Address: 1882I 1 1th Ave NE City,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Z.ip:Arlington,WA 98223 Phone: Phone:206-660-7442 Phone:206-660-7442 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name:NW Custom Plumbing LLC Address: Address: 18821 1 lth Ave NE City,State,Zip: City,State,Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 LIC#: EXP: LIC M EXP: JOB DESCRIPTION PERMIT TYPE: Residential Plumbing CODE YEAR: 2412 STORIES: 1 CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: 1 OCC LOAD: PERMIT APPROVAL 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 1827. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBCI10/IRCI 10. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sates tax return form and coded City of ArbngWn#3101. Signature Print Name —��—�Date Released By Date CONDITIONS Approved per Building Inspector site review. THIS PERMIT AUTHORMS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 5/16/2016 Plumbing Permit Base Fee $25.00 5/16/2016 Plumbing Permit Fee(Enter Fixture Fee) $72.00 5/16/2016 Water Heater $25.00 Total Due: $122.00 Total Payment: $0.00 Balance Due: $122.00 CALL FOR INSPECTIONS BUILDINC(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon ; I CITY OF ARLINGTON 238 N. OLYMPIC AVE -ARLINGTON, WA. 98223 _- PHONE; (360)403-3551 BUILDING PERMIT Address:3319 176th PI NE Permit#:1011 Parcel#:00621300009300 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:BOSLEY DONNA SUE Name:NW Custom Plumbing Name:NW Custom Plumbing LLC Address:3319 176TH PL NE Address:18 821 11th Ave NE Address: 18821 1 lth Ave NE City,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 Phone:206-660-7442 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name:NW Custom Plumbing LLC Address: Address: 18821 1 lth Ave NE City,State,Zip: City,State,Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 LIC#: EXP LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Residential Plumbing CODE YEAR: 2012 STORIES: 1 CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: t OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded City of Arlington#3101. 0�� lG/lam Signature Print Name Date Released By Dde CONDITIONS Approved per Building Inspector site review. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION, PERMIT FEES Date Description Fee Amount 5/16/2016 Plumbing Permit Base Fee $25.00 5/16/2016 Plumbing Permit Fee(Enter Fixture Fee) $72.00 5/16/2016 Water Heater $25.00 Total Due: $122.00 Total Payment: $0 00 Balance Due: $122.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON,WA.98223 PHONE; (360)403-3551 BUILDING PERMIT Address:3319176th PI NE Permit#:1011 Parcel#:00621300009300 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:BOSLEY DONNA SUE Name:NW Custom Plumbing Name:NW Custom Plumbing LLC Address:3319 176TH PL NE Address:18821 1 nth Ave NE Address:18921 11th Ave NE C ity,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 Phone:206-660-7442 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name:NW Custom Plumbing LLC Address: Address:18821 1 lth Ave NE City,State,Zip: City,State,Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 LIC#: EXP. LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Residential Plumbing CODE YEAR: 2012 STORIES: I CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMENS COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID_ IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. [BC110/IRC110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded City of Ar. H3101. Signature Print Name Data 20 Released By Dafe CONDITIONS Approved per Building Inspector site review. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPFItTY ONLY_ ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 5/16/2016 Plumbing Permit Base Fee $25.00 5/16/2016 Plumbing Permit Fee(Enter Fixture Fee) $72.00 5/16/2016 Water Heater $25.00 Total Due: $122.00 Total Payment: S0.00 Balance Due: $122.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon CITY OF ARLINGTON % 238 N. OLYMPIC AVE -ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:3319176th PI NE Permit#:1011 Parcel#:00621300009300 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:BOSLEY DONNA SUE Name:NW Custom Plumbing Name:NW Custom Plumbing LLC Address:3319 176TH PL NE Address:18821 11th Ave NE Address: 18821 1 Ith Ave NE City,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 Phone:206-660-7442 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name:NW Custom Plumbing LLC Address: Address: 18821 I Ith Ave NE City,State,Zip: City,State,Zip:Arlington,WA 98223 Phone: Phone:206-660-7442 LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Residential Plumbing CODE YEAR: 2012 STORIES: I CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: 1 OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC1I0/IRCI I0. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded City of Arlington#3101. Signature Print Name Date Released By Dd, CONDITIONS Approved per Building Inspector site review. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 5/16/2016 Plumbing Permit Base Fee $25.00 5/16/2016 Plumbing Permit Fee(Enter Fixture Fee) $72.00 5/16/2016 Water Heater $25.00 Total Due: $122.00 Total Payment: $0.00 Balance Due: $122.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon ritFcl01f Fe 00 wAT-CRZ- Permit Information Date 5/11/2016 Permit Number 1011 Project Name Robert and Donna Bosley Applicant Name NW Custom Plumbing Applicant Address 18821 11th Ave NE City,State,Zip Arlington,WA 98223 Contact Brent Besancon Phone 206-660-7442 Email brent.nwcp@outlook.com Permit Type Residential Plumbing Site Address 3319 176th PI NE Valuation 0.00 Status Applied Permit Issued Permit Expires Square Feet 0 Type of Construction/Occupancy Load Number of Stories 1 Proposed Use Replace plumbing due to fire damage. Assigned To Property Information Owner Information Parcel#:00621300009300 BOSLEY DONNA SUE BOSLEY DONNA SUE 3319 176TH PL NE 3319 176TH PL NE ARLINGTON,WA 98223 Contractors Contractor Name Primary Contact Phone Email Contractor Type License License# 14W Custom Plumbing LLC 113rent Besancon 206-660-7442 brent.nwcp@outlook.com JPLUMBING CONTRACTOR Review Date Tvpe Description Target Date Completed Date Assigned To Status 5/11/2016 Residential Plumbing 5/18/2016 JKevin Olander Jin Review Uploaded Files I Upload File Date File 5/11/2016 12:38:24 PM 11011 Applicationdf i RESIDENTIAL PLUMBING l PERMIT APPLICATION Department of Community& Economic Development City of Arlington• 18204 59th Ave NE•Arlington,WA 98223 • Phone(360)403-3551 THIS APPLICATION IS TO BE USED WHEN APPLYING FOR NEW PLUMBING INSTALLATION FOR EXISTING RESIDENCES. PLEASE FILL OUT ALL PAGES OF THIS APPLICATION AND INCLUDE ALL INFORMATION. Project Address: �� 1 �� 1 L` �`✓ �c�� 'G� �'`� �� J - 1 Project Description: - - Owner: - Address: ��q 7(Jo�' City: � �`�Ic��'�r�� State: �� Zip Code: Phone: Email: Applicant: (15 - (A �q_aa - Address: City: State: Zip Code: Phone: Email: �r CONTRACTOR INFORMATION Contractor Name: 'V W5h1 1�4�'a Address: l%J �y� �� City:: ��d� State: 1( Zip Code: License Number\JbO - _ Expiration:4 Phone: W0 OV) , Email: +l lNa4 60166N Gdy Receivecl STAFF USE ONLY Permit#: Accepted by: Date RESIDENTIAL PLUMBING PERMIT APPLICATION Department of Community& Economic Development City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone(360)403-3551 Plumbing Section (check all that apply) (Check all that apply and indicate the number of fixtures proposed) ❑ Bath/Shower Combo (4.0) x ❑; Sink (1.5) x Shower(2.0) x I ❑ Lavatory(1.0) x l ❑ Clothes Washer(4.0) x L ❑ Water Closet(2.5) x ❑ Dishwasher(1.5) x ❑ Water Heater x ❑ Hose Bibb(2.5) x z ❑ Other(list) d Proposed Water Piping Size: Proposed Piping Material: 7E Proposed DWV Material: (9-65 Proposed DWV Size: • All hose bibs required to be equipped with Atmospheric Vacuum Breakers per ASSE 1019 • All water supplies at 80psi or greater shall have Pressure Reducing Valves (PRV) • Cross-Connection-Control may be required Applicant Signature: ��ti-- Date: I hereby certify that the above information is correct and that the construction, installation for the above mentioned property will be in accordance with the applicable laws of the City of Arlington and the State of Washington. Search L&I A-Z In CALa"bori f HealthSafety & ; Insurance Workplace Rights Washington State Department of Labor & Industries NW Custom Plumbing LLC Owner or tradesperson 3405172ND ST NE 5-158 ARLINGTON,WA 98223 Principals 206-660-7442 Besancon, Brent Allen, PARTNER/MEMBER SNOHOMISH County Besancon, Brent Allen, AGENT Doing business as NW Custom Plumbing LLC WA No. Business type A business registered as a 660337345 Limited Liability Company ontrattor with L&I to p2rforr )e of Its License istruct Verify the contractor's active registration/license/certification (depending on trade)and any pa'sYv0afians:"" f i� Construction Contractor Active. Meets current requirements. License specialties PLUMBING License no. -��- NWCUSCP861 CS Ef ecfive=expiration 02/10/2014—02/10/2018 Bond Wesco Insurance Co $6,000.00 Bond account no. 46wb042233 Received by L&I Effective date 02/10/2014 02/10/2014 Expiration date Until Canceled Insurance Ohio Security Ins Co $1,000,000.00 Policy no bks55743656 Received by L&i Effective date 01/13/2016 02/10/2014 Expiration date 02/10/2017 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L8d Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&i ,account iD Account is current. 285,684-00 Doing business as NW CUSTOM PLUMBING LLC Estimated worker-s reported Quarter 1 of Year 2016 "4 to 6 Workers" L&' account representative T2/LINDA ALGUIRE (360)9024678-Email: POTH235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Wasidrigtor)Stag Dept of Labor&industrIes. Use of thIs slt Is aubiect to the la�,Ls of Che state of�Ijasnl oton i Permit#: 1011 Permit Date: 05/11/16 Permit Type: RESIDENTIAL PLUMBING Project Name: Robert and Donna Bosley Applicant Name: NW Custom Plumbing Applicant Address: 18821 1 Ith Ave NE Applicant, City, State, Zip: Arlington,WA 98223 Contact: Brent Besancon Phone: 206-660-7442 Email: brent.nwcp@outlook.com Scope of Work: Replace plumbing due to fire damage. Valuation: 0.00 Square Feet: 0 Number of Stories: 1 Construction Type: Occupancy Group: ID Code: Permit Issued: 05/16/2016 Permit Expires: 11/16/2016 Form Permit Type: Status: LASERFICHE Assigned To: Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 00621300009300 3319 176TH PL NE BOSLEY DONNA 111 Single Family SUE Residence-Detached Contractors Contractor Primary Contact Phone Address Contractor Type License License# NW Custom Plumbing Brent Besancon 206-660-7442 18821 11thAve CONSTRUCTION Labor&NWCUSCP861CS LLC NE CONTRACTOR Industries Inspections Date Inspection Type Description Scheduled Date Completed Date Inspector Status 05/18/2016 C04.PLUMBING 05/17/2016 BUILDING Approved GROUNDWORK Plan Reviews Date Review Type Description Assigned To Review Status 05/11/2016 RESIDENTIAL BUILDING PLUMBING Fees Fee Description Notes Amount Plumbing Base Permit Fee $25.00 Mechanical Commercial Permit Table 4-7;Per Unit $72.00 Water Heater(Tank) $25.00 Total $122.00 Attached Letters Date Letter Description 05/16/2016 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 05/16/2016 Brent Besancon 59639793 cc $122.00 Outstanding Balance $0.00 Uploaded Files Date File Name 05/17/2016 1626930-1011 Permit.pdf 05/11/2016 1617442-1011 Application.pdf