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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—�nnv�.everethva.otg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> 2216 BROADWAY 00439147502500 ��Z 0 - � <br /> LEGAL LOT NO. BLOCN TRACT <br /> DESC. <br /> OWNER ADDRESS QTY21P PHONE <br /> ALBERT ALDERMAN 2216 BROADWAY Everelt98201 425-259-6218 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,l�nnif�;r Burgess 206-774-9499 <br /> COIJTRACTOR \A�ESCO ADDRESS pTMWooa saoss Pg00-398-4663 <br /> V° 3909 196 St SW, Y <br /> CONTR.LICENSE#WASHIES97 I OB <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORFC <br /> Residential I _Electric �Gas_Other $']5Q <br /> WORK DESCRIPTION <br /> Replace 40 gal gas water heater <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIRTURE OR ITEM <br /> Toilet A/C—airhandling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sinh(service/barlmopletc.) _ Exhaustfan <br /> Bachilow preventer _ Heat pwnp <br /> Urinal Unit heater <br /> Drinking Fountain _ Boilet <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstwe <br /> Roof drains Other_ <br /> i�ther <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certtify that I have read antl examined this application and know the same to be true and correct. All prwisions of laHs and <br /> ordmaces govemmg thistype of work will be mmplied with whethe�specified herein or not.The grenting of a permit tloes not presume <br /> to give aathority to oiolate or cancel the provision of any other stafe or local law regulating mnstruction or the pedormance of <br /> construc;�on. That I am authorized by the owner of this property to pertorm the work for whkh application is made and I comply wrth the <br /> Slate CCntraCtorS LaW 18.27 RCW an0 296.POO W�C. r x�e��gnf <br /> JenniferBuraess ���wq�,o,u�����mn��»�n,mi��m��-�s�6u�•ear�nmut <br /> Signature of Owner/Contracto Authorlxtl � n "- ' " � " ' Date <br />