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=�0:-�-5 �L. /�c�r �— i <br />PtRMIT' .APPLICATI(�N <br />C'ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />LyZ3 �zcTv��i�w,2 .,3vi� <br />SITE ADDRESS <br />S�p�Z�% GOG�J�i�G �O �j <br />LEGAL LOT NO. BLOCK <br />DESC. � �/� <br />OWNER J <br />�/�/9/26� ���tS�Z�L/ <br />TE��AME <br />� <br />CONT�j ACTOR <br />/Yc�Cviz,'f �r �aa1'S! Cd <br />�—�-p3 <br />i�t�a - <br />och ��,�� a�n d l3 �� �-aMir�—'� <br />�3 0 � -� ��d ��.3 ����7-OZ/ � <br />TRACT �� <br />ADDRE • /` � ���7 PHONE <br />3G o `�3- � <br />r�/ic)/�✓� /3f:� l/�9,5 i'(�52`1'J'Cl/L� � `?�Z/ <br />CONTACT FOR PF.R MI7 PHONE <br />S./r�/�Q.J v��OrEGS �/Zf� � Cn O��"/ �c� S�� <br />ADDRE55 � 'LIP CONTR. LICENSE # <br />i3c�x /�G�S n�lY2YS��t� .��LTO R�cv2U_Od <br />PHONE �C�Q ��o S S�'� G�O9� 7 ZS�` b 7Co —.>.�Sd "' <br />PROPOSED USE OF BUILDING <br />PRICE OF WORK <br />PERMIT �Combination j}�Plurr <br />7YPE Demolition � Sign <br />Sprinkler <br />du�, `= <br />n Addilion HEATSOURCE <br />ISb'AlteraCon Electric <br />� New �Gas <br />�r1 RepaidMaint. L� Other <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION /����y�� � ��,f�oGAG� SN��/J /zUO/� lic//i C{ �t,(S,s <br />G� C'c�1x.rP izo o%i�/S - Gl P O.� T� � L�� i iz � c•� t+� /�� ,� .�-r c3i-✓ <br />!�/i' ��I2 rGt/� nl —/�•� S r�GL � w 5 Jt_.i4Tio�� .:�F�/l£2 �� L 22 �i�CS <br />�'���u.� ���i�r`Ti /i✓� /i N4 SiQi�fJ .— wFt.c.i tc!/NC�d cJS� /�'i <br />G /-lD1.�r�� /=c�aJr�/4/c ro /�D�cs:` /Joo; •r��Z��/T <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 JISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />Oi'HER <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C-A/HANDLING UN�TS <br />FORCEO AIR SYSTEMS <br />HEAT PUN.P <br />UNITHEAI"ERS ��Ip/zOn�/� A2'��`� <br />CLOTHES DRYER ���� � <br />RANGE HOOD <br />WATER H cATER <br />METAL FII2EPLACE/uTOVE <br />FIREPLAC;E INSER i <br />GAS F�REPLACE <br />GAS RANGc <br />GAS PIPIIVG <br />EXHAUSTFAIJ- �5P9i i� <br />OTHER <br />i HEREBY CERITIFY THAT I HAVE READ AND EYAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANC� CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIUINACES GOVERNING T1115 TYPE OF INORK WILL OE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGL'LATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIO�I. THAT I AA4 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND t COMPI.I' WITH THE STATE <br />CONTRA(�TORS LAW 18.27 -W AND 296.200 WAC. <br />���c'=,_, �i�'c' `/ p � ZO v� <br />Signature of Owng` ontr� NAuthorized Agent Date � I <br />/ � <br />DEBI'i & CREDIT CARDS ARE NOT ACCEPTED <br />