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PLUMBING PERMIT.AI'5PLICATION <br />D (9�U v <br />EVERETT CITY OF EVERETT PERMIT SERVICE0 S MAR 14 2024 <br />SUBMITTAL INSTRUCTIONS: Drop off hard copy cornpteted paper application to 3 edar Street 2nd Floor Intake Drop Box. <br />WASHINGTON CONTACT INFORMATION: (P) 425-257-8810 1 (E) permitServices@evere"a.gov i (oMT\Yr tfe. fiVEiFitETT <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION ermi t rvic <br />21732 HIGHLAND <br />PROJECT SITE ADDRESS: STREET PgRCEL #: 00453445303100 <br />CITY EVERETT STATE WA ZIP 98201 <br />SUITEIUNIT #: FLOOR M AQD'ITIONAL LOCATION INFORMATION: <br />TENANTIBUSINESS NAME (if non-residential): <br />CONTACT INFORMATION <br />OWNER NAME:ALI SEID IVIOHAIVIIVIED ' <br />OWNER MAILING ADDRESS: STREET 2132 HIGHLAND ST <br />CITY EVERETT STATE WA ZIP 98201 <br />OWNER PHONE: 206261 7592 <br />OWNER EMAIL: 86idall99@gmall.COm <br />CONTRACTOR COMPANY NAME: TBD <br />WA STATE CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIREQ- <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE i;, ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR © OTHER (Please Specify) Designer <br />CONTACT NAME: <br />Joey Perez <br />CONTACT PHONEi: 2062407006:;= <br />CONTACT EMAIL:, <br />Joeydesig nII28gmall.COm <br />PLUMBING PERMIT INFORMATION <br />VALUATION OF WORK: $ 9000 <br />ASSOCIATED PERMIT # if a plica6li'4 <br />(Valuation shall include the prevailing fair market value of all labor, materials, and equipment needed to complete the work, whether acual y paid or not.) <br />BUILDING TYPE: ©SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />DESCRIPTION OF WORK: <br />adding 3.5 bathrooms + laundry room + 2nd kitchen <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 />I <br />List of Fixtures Y' <br />r: <br />Backflow Prevention Device (Inside Building) -select devices below. <br />Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA <br />3 <br />Shower, Tub, or Conti)o <br />Commercial Sink (3-aD 4rtment, prep, floor) ;+ . <br />1 <br />Clothes Washer <br />t <br />Residential Sink (kitc)06. bath, bar) <br />t <br />Dishwasher <br />Utility Sink (laundry, pop) i <br />Drinking Fountain <br />4 <br />Toilet <br />Floor Drain <br />Urinal <br />Hose Bibb <br />Waste/Water Pipe I air <br />Ice Maker <br />Water Service Line Eehind meter, private side) <br />Grease Interceptor <br />Water Valves/Fiat iW <br />Sand/Oil Interceptor <br />t <br />Water Heater -Ell cter <br />Medical Gas <br />Water Heater - Gas <br />Roof Drains <br />1 <br />Other (List Type): <br />1 <br />Sewage Ejector Pump/Sump Pump <br />Other (List Type): <br />ACKNOWLEDGEMENT: / have reviewed this application and confirm the information contained herein is true and correct. Mork done pursuant to this perrrti;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 authorizeoin writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or / am authorized by the owner of this property to perform the work for 4ch application is made, <br />and / comply with the State Contractors Law 18.27 RCW and 296.200A WAC, <br />P03 / 14 / 2024 City of Everett Official Up Only <br />PERMIT# PC;') <br />Owner/Authorized Agent Signature Date (Revised 4,12112022) <br />Doc ID: fb26aba4846fc3a5f090e3tO596a34579b2f05d1 <br />