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PERMIT 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 />SITE ADDRESS / <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER /J <br />So C pe,,CC L omnfyr/i ��� <br />TENANT NAME <br />CONTRACTOR <br />,n,,.OP t (_�cNra Ao_?'U 2 <br />CONTR. LICENSE p <br />USE OF BUILDING <br />Char A <br />WORK DESCRIPTION <br />RFSr1200)" T'^'lillim'- <br />Tills <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbarlmoplelc.) <br />BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />1 "; <br />TRACT <br />PARCEL TAX I.D. # <br />n' Dr" 4D//00 <br />J0$ 4jTWJiR P},U QL 0 C#I` •� <br />he-,). j1.i,fi�11* 4)ivhr?lgl <br />ADDRESS CITY/ZIP <br />HEATSOURCE <br />_ Electric -X Gas_ Other <br />PHONE <br />OWN.' 411*317- <br />4.25 :59-G193 <br />PHONE <br />GUN I KNI.I me : v� <br />M <br />NO. I TYPE OF r'XTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boller <br />Refrigeration <br />Woodstove <br />Other. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3100 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit doer, not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of I <br />construction. T I am aulho0 ad owner of this property to pert rm lh work for which application is made and I comply with the <br />