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{ OttV r' - 1,�-tr IPROPERTY TAX#: <br /> PROJECT SITE ADDRESS: 7 S 5" S <br /> LEGAL for new construction: Short Piatisutxiivi Lot No (attach e ng legal description) <br /> x8ia 0-., ,.0 <br /> , 70. ...?'F.. ._»,.. rvT�+ $t�4�.� _ _ a.� . x., .�.. amu. _... <br /> OWNER NAME: .�.iZ.�.�+.�.».AK. .. Prt . <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> 7PCIT( STATE_ .... <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: Pk. c 4- V V -F'9 'n <br /> CONTRACTOR ADDRESS: STREET t 9 ) ' 1 J <br /> GIN J`i J ) + STATE LA F ZP 7:42/0,;)/:-.:ci(S CONTRACTOR EMAIL•CONTRACTOR PHONE: ��5'75-� ' 7-f -p ��-(CITY OF EVEREIT BUSINESS LICENSE#(REQUIRED): 0 <br /> CONTRACTOR LICENSE#(REQUIRED): S�{ fl(SIF"ti.7 �S .3 ! 1.. <br /> h�✓ <br /> PRIMARY CONTACT: O OWNER C 1 CONTRACTOR Q OTHER(Please Specify) :. A�1e <br /> CONTACT NAME: AA of_ <br /> S G y` CONTACT PHONE: l , 7S� - `f 7 `( ) <br /> CONTACT EMAIL: cjel a,t C,. 64-1,0 Ca s ). Aft.--1" <br /> aa ' ��y ERMI APPL1CATION� ;M 2-z, �.,_. .. <br /> r7 �''"s y"c .��'^'�'' s,.3a�t,,, ..,.a?,:� ..'3r.� aw5,,„�.fix!lr�V�L�E��F��. ,.......„���....� ,,, .,.. .n. .. u <br /> Existing Use of Building: ‘-{.S N i'IR 1 � � ��p <br /> Contract Price of Work:'.$ (o <br /> ' ( V` '''T ®Gas ❑Electric Clatter_ <br /> Proposed Use of Building: ( S F Heat <br /> Building Type: IgFR-Detached EISFFRR-Attached ODupiex ElMulti-Family-#of Units: <br /> DCommeraal ['Industrial <br /> Type of Project QNew DAddition_ erg-model DRepair OT.I.. ❑Sign ❑Sprinkler ODemolition OChange of Use <br /> DESCRiPTfON OF WORK: r`p 9 L-e_ o 1 I.1,,,, Li}k, 1 vl G( /z c,1 J CI ( <br /> tt <br /> tk 4 C t e(9 LA]diA isfA,J <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> M.ECHANIrC PERIfl:.�.. .... . t r .,r.`. of -PE . AP_L. <br /> Ltotoa r '" , <br /> Type'of Project _New Addn Alteration Repair Type Project: _New _Addn 44Arteration _Repair <br /> #of #of List of Fixturos <br /> #of List of FfxWrt'.s <br /> Fixtures list of Fixtures Fixtures List of Fixtures Fixtures R <br /> NC-Air Handling Units Heat Pump f Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> I Gas Piping Boiler j Lavatory(Wash Basin) Drinking Fountain <br /> I • Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove f Kitchen Sink&Disposal Grease Trap <br /> I Gas Range Ducting ) Dishwasher Roof Drains <br /> f Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> I Range.Hood `//\]Afaty H ter Other: <br /> ! Exhaust Fan Sink(Servi r/Mopietc.) Other. <br /> v .SPRINKLER!S P'PRESSI.O SYS t'EN '. <br /> chemical or Water I 'No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application andconfirmthe information contained herein is five and correct.Work done pursuant to thispermit must comply with <br /> current federal,state,and local law The granting of a pemat only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official being authorized under anycirar,��once f am the owner,ori am authorized by the owner of this property to perform Hie work for which application is made, <br /> and i comply with h the the State Contractors Law 1,27-• and 296200A WAC: <br /> City of Everett Official Use Only <br /> ii t"_ / PERMIT\1 <br /> 1 Li ZS ��7 ill l <br /> Owner/A i orized Agent Signature - Date ! (Revised 9/232016)x`"[ <br />