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SITE ADDRESS <br />LEGAL LOT NO. <br />oEs�. � � i <br />Pr.�RMIT /�PPLICATIUN <br />ClTY OF EVERETT PERMiT SF..RVICES <br />3200 CEDAR STREET, EVERETT, WF, y8201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />Co9•953�14b �lOv <br />BLOCK TRACT OR SUBDIVISION # � <br />oi� c����E�. })Ei�,h� S <br />PERMIT # <br />S�r, �ri_ Mv��' 2�,gli F�veFti,c� ,ocQEs �� MONROE 4�L.S-�Q�- I t'lZ <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />E-�1AIL <br />......�.,...�..� AODRESS CITY2IP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />5�����It �',� <br />WORK DESCRIPTION <br />�C-S <br />CcNS�i.'(nl/�a <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other _ <br />HEAT SOURCE <br />_ Eleclric i� Gas _ Other <br />� l�{rr� 1� T:: <br />NO. <br />CONTRAC7 Prtict ur wuKn <br />� � �J3 9i� <br />� <br />V �ceM�,� 1 S <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />rorced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unit heater <br />Boiier <br />Re(rigera!ion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined lhis applicalion and know the same lo be lrue and correct. All prnvisions of laws and <br />ordinaces governing lhis lype of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give aufhority lo violate or cancel lhe provision of any other stale or local law ragulating construclion or the pedormance o( <br />constrrc}ion. That 1 am authorized by lhe owner o( this property to periorm lhe work for which applicalion is made and i comply wilh lhe <br />Slate lCop lraclors Law 18.27 RCW and 296.200 WAC. �j <br />, -�S ,. �'�f/,�C) S' l/ � (� / <br />