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9 _ <br /> P�rtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS SuZ WA✓ERL A✓E PARCELTAXI.D.A PERMI7R <br /> E��,�FTT �v� 9s'�i M c�l�o3 c.�S <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIlY21P PMONE <br /> Sorr OLSL�nI So2 W,!✓f/1Z-y �}�� -�yl�@`��A !n'?o/ ( `�ZSl��9/ri9 <br /> TENANTNAME CONTACTFORPERMIT PXO <br /> o�„i�F� I 'c�Tr O�SEnJ Cy�s 339-/5�/ <br /> CONTRACTOR Q��� Q ADDRESS qTY21P PHONE <br /> /� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /QC S/JJLNC� _Eledric _Gas_Other .�/9�� <br /> WORKDESCRIPTION � �J SyS?tr�„� <br /> ZivSTAL( F�T ti,N <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air syslams <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> _ Sink(service/bar/mop/elc.) Exhaust fan <br /> _ BackFlow preventer � Heat pump <br /> Urinai Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap WooAstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby cerilify Ihat I have read and examined this applicalion and know lhe same lo be irue and correcL All provisions of laws and <br /> ordinaces governing this type ol work will be complied with whether specified herein or not.The granling of a pertnil doec�.nl presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance r.� <br /> construction. That 1 am authorized by the owner of this property to peAorm the work for which application is made and I con::d�with lhe <br /> State Contra o s`aw 18.27 RC� 86200 WAC. <br /> ���� <br /> Signature f OwnedCor�f actor/Authorized Agent Date <br /> �� <br />