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PLUMBING PERMIT APPLICATION <br /> EVERETT SUBMITTAL INSTRUCTIONS: <br /> OF EVERETT PERMIT SERVICES <br /> S: Drop off hard copy completed paper application to 3200 Cedar Street 2nd Floor Intake Drop Box. <br /> WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: STREET 620 se Everett Mall Way#230 PARCEL#: Kitchen preparation commercial inspection. <br /> CITY Everett STATE Washington ZIP 98208 <br /> SUITE/UNIT#: 230 FLOOR#: 1 ADDITIONAL LOCATION INFORMATION: <br /> TENANT/BUSINESS NAME(if non-residential):Ladun Treats <br /> CONTACT INFORMATION <br /> OWNER NAME:Lidiia Hladun <br /> OWNER MAILING ADDRESS: STREET 11426 3RD PI W <br /> CITY Everett STATE WASHINGTON ZIP 98204 <br /> OWNER PHONE:425-350-8091 OWNER EMAIL:Laduntreats@gmail.com <br /> CONTRACTOR COMPANY NAME: <br /> WA STATE CONTRACTOR LICENSE#(REQUIRED):TENANT CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): TENANT <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> PLUMBING PERMIT INFORMATION <br /> VALUATION OF WORK: $1 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: <br /> Existing kitchen <br /> PLUMBING PERMIT FIXTURE COUNT (SCOPE OF WORK) <br /> Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures <br /> (Qty) (Qty) <br /> Backflow Prevention Device(Inside Building)-select devices below: o Shower,Tub,or Combo <br /> Fire Service: ❑DCDA, Domestic Service: ❑RPBA❑DCVA 1 Commercial Sink(3-compartment,prep,floor) <br /> o lClothes Washer 1 Residential Sink(kitchen,bath,bar) <br /> o Dishwasher 1 Utility Sink(laundry,mop) <br /> o Drinking Fountain 1 Toilet <br /> o Floor Drain o Urinal <br /> o Hose Bibb o Waste/Water Pipe Repair <br /> o Ice Maker o Water Service Line(Behind meter,private side) <br /> Grease Interceptor o Water Valves/Fixtures <br /> o Sand/Oil Interceptor 1 Water Heater-Electric <br /> o Medical Gas o Water Heater-Gas <br /> o Roof Drains Other(List Type): <br /> o Sewage Ejector Pump/Sump Pump 1 1 Other(List Type): <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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#TENANT <br /> 03.20.2025 <br /> Owner/Authorized Agent Signature Date (Revised 412112022) <br />