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477 PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> P OJEC 1TE ADDRESS: PROPERTY TAX#: <br /> 'i�l�� FoY��S� Dn. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> .'• _. CONTACT INFORMATION <br /> OWNER NAME: "S7 E\) E 0 SALMON TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET %-k k7 Z Foie CST pQ. f� �j Q ^` <br /> CrrY IL,a C 1T T STATE W I"'j ZIP -1 p2-v- <br /> OWNER PHONE: CPB f{ - 1 tO O— ( 32 3 OWNER EMAIL: <br /> CONTRACTOR NAME: AA/O f:25©.n/ R,-4-6/°erie'E <br /> CONTRACTOR ADDRESS: STREET 0 27 131-0/9-O i v <br /> cm Fi Vt_CETT STATE UJA— ZIP q g2© I <br /> CONTRACTOR PHONE: 6./2-5) Z S / 9 CONTRACTOR EMAIL: APP. 040 fi52-5 �/G'it�t el, �. co" <br /> CONTRACTOR LICENSE#(REQUIRED): /AN OCR /V t co ) Li CITY OF EVERETT BUSINESS LICENSE#(REQUlRED): c�)3 51 <br /> PRIMARY CONTACT: (id OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> ..a.t:,t ,..; . _ ,,,' BUILBINdMERMIT APPLICATION :tt „ ,.: ,;:. . ' <br /> AqitgtgdAi <br /> Existing Use of Building: Contract Price of Work:$ Coq 9 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New IZIAddition 0 Remodel 0 Repair ❑T.1. ❑Sign ❑Sprinkler ['Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: gct1/4>1 S 0,\ts0,A s �ot^'1 mete rtv, 3 cis ` 'SerF. <br /> JJ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): JJ <br /> ,' ,MECHANICAL PERMIT APPLICATION , .. , ,;PLUMBING:PERMIT APPLICATION ,, <br /> Type of Project: •New_ Addn Alteration Repair Type of Project: New _Adds Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) q <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM..;:, ) <br /> Number of Heads <br /> ACKNOWLEDGEMENT:f 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.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � <br /> PERT ©'l <br /> Owner Authorized Age ` S gnature Date (Revised`10/112/2015) <br />