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PLUMBING PERMIT APPLICATION <br />EVERETT <br />WASHINGTON <br />CITY OF EVERETT PERMIT SERVICES <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br />CONTACT INFORMATION: (P) 425.257.8810 1 (E) everetteps@everettwa.gov I (W) everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: STREET: PARCEL M <br />cITY Everett STATE WA zip 98 <br />SUITE/UNIT M FLOOR M 1 ADDITIONAL LOCATION INFORMATION: Storage BLDG <br />TENANT/BUSINESS NAME (if non-residential): City of Everett <br />CONTACT INFORMATION <br />OWNER NAME: City of Everett <br />OWNER MAILING ADDRESS: STIEET2930 Wetmore Ave <br />cITY Everett STATE WA zip 98201 <br />OWNER PHONE:4252578700 <br />IOWNEIR EMAIL: N/A <br />CONTRACTOR COMPANY NAME: Hermanson Company <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): HERMACL792NW <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 37262 <br />CONTRACTOR ADDRESS: sTREET1221 2nd Ave N <br />cITv Kent STATE WA zip 98032 <br />CONTRACTOR PHONE:2066386961 <br />1CONTRACTOR EMAIL: kwilllams@hermanson.com <br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />Kennedy Williams <br />CONTACT PHONE:2066386961 <br />CONTACT EMAIL: kwilliams@hermanson.com <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $33,000.00 ASSOCIATED PERMIT # (if applicable): <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) <br />BUILDING TYPE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi -Family - # Units: OCommercial ❑Accessory Structure <br />DEscRIPTION OF WORK: Installation of (3) floor drains, (3) hose bibbs, (1) trap primer box, (1) water closet, (1) <br />lavatory, (1) instahot, and (1) reduced pressure backflow. <br />PLUMBING PERMIT FIXTURE <br />COUNT (SCOPE OF WORK) <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Fixture <br />Count <br />(Qty) <br />List of Fixtures <br />Backflow Prevention Device (Inside Building) -select devices below: <br />Fire Service: ❑DCDA, Domestic Service:❑RPBA ❑DCVA <br />Shower, Tub, or Combo <br />Commercial Sink (3-compartment, prep, floor) <br />Clothes Washer <br />1 <br />Residential Sink (kitchen, bath, bar) <br />Dishwasher <br />Utility Sink (laundry, mop) <br />Drinking Fountain <br />1 <br />Toilet <br />3 <br />Floor Drain <br />Urinal <br />3 <br />Hose Bibb <br />Waste/Water Pipe Repair <br />Ice Maker <br />Water Service Line (Behind meter, private side) <br />Grease Interceptor <br />Water Valves/Fixtures <br />Sand/Oil Interceptor <br />Water Heater - Electric <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />1 <br />Other (List Type): instahot <br />Sewage Ejector Pump/Sump Pump <br />11 <br />1 Other (List Type): trap primer box <br />ACKNOWLEDGEMENT: / have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />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 <br />Building Official before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />Digitally signed by Kennedy Williams <br />DN: CN=Kennedy Williams, OU=SPD, OU=Department PERMIT # <br />Kennedy Williams DUser AccC hermanson DCHocalanson Company, DC=corp, <br />Date: 2022.03.29 07:16:52-07'00' <br />Owner/Authorized Agent Signature Date (Revised 21812021) <br />