9538 HOLLY DR 2025-07-10 - Laserfiche WebLink

PLUMBING PERMIT APPLICATION EVERETT WASHINGTON CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 425-257-8810 1 (E) PermitServices@everettwa.gov I (W) everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: STREET PARCEL M CITY STATE ZIP SUITE/UNIT M FLOOR M ADDITIONAL LOCATION INFORMATION: TENANT/BUSINESS NAME (if non-residential): CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR COMPANY NAME: K t1 WA STATE CONTRACTOR LICENSE #(REQUIRED): CITY F EVERETT BUSINESS LICENSE #(REQUIRED): CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: PLUMBING PERMIT INFORMATION ��`` VALUATION OF WORK: $ ( O V ASSOCIATED PERMIT # (if applicable): I l (Valuation shall Include the prevailing fair ma et value of all labor, materials, and equipment needed to complete the work, whether actually paid or not.) BUILDING TYPE: ❑SFR ❑Townhouse []Duplex ❑ADU ❑Multi -Family - # Units: []Commercial ❑Accessory Structure DESCRIPTION OF WORK: PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) Fixture Count (Qty) List of Fixtures Fixture Count MIA List of Fixtures \� Backflow Prevention Device (Inside Building) -select devices below. Fire Service: ❑DCDA, Domestic Service: ❑RPBA ❑DCVA Shower, Tub, or Combo 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # V-2,�OU_ Owner/Authorized Agent Signature Dat (Revised 412112022)