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- -� -� ------ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857— �+nvw.everettwa,org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT it <br /> 4609 ELM ST ooaa9500o��600 M13�8-dz3 I <br /> LFGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 O7Y21P PHONE <br /> EMILIA A BELL 4609 ELM ST Everett98203 425-737-0564 <br /> TENANT NAh1E CONTACT FOR PERMIT PHONE <br /> INaida Khan 360-945-2787 <br /> COt�TRACTOR \A/ESCO ADDRESS CEN21P PHONE i <br /> �� 3909 196th St SW Lynnwood 800-398-4663 <br /> CONTR. LICENSE H WASHIES�7 1 OB <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORI( <br /> .SFR _Eiectnc �Gas_other $950 . <br /> WORK D[SCRIPTION <br /> REPLl10E GAS WATER HEATER. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEf,1 NO. TVPE OF FIXTURE OR ITEIA <br /> Todet A1C—av hantllmg umts <br /> Bathtub Forced air systems <br /> Lavatory (vrash basin) � Gas piping <br /> Shower + Water hCOler <br /> KikhEn Si�k& tli5p0531 Gas Lreplace <br /> D�shwasher Gas range <br /> Clothes vnsher Ciothes tlryer <br /> Laundry iray Range hootl <br /> Snk (servicel�admop/etc) Exhaust fan <br /> Backllow preventer Heat pump ' <br /> Unnal Umt heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refngeration <br /> Grcase trap Wootlstove <br /> ^ Roof drams Other <br /> Othcr <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> 1 hereby ceritity that I have read and examined this apphwlion an� know the same to be true and correct All provisions of laws and <br /> o•y�naces goveming this rype ol vrork Nnll be comphetl vnih whether speafied herein or not. The granting of a permit tloes not presume <br /> to grve authonty to violate or cancel Ihe provision of any other state or local law regulating construc6on or the peAormance of <br /> ccnSlruCliOn Thdt I dm 3uihOfiZCd by thC OwnC�Of IhiS pfOpCrty l0 pertO�m Ih0 wa�K 10�which�pphCeliOn 6 rttOdC antl I cOri�ply wdh thC <br /> SL�te Contractors Lav+18.27 RCW antl 296.200 WAC. <br /> Naicla Kha�. U,���,�;����",�"�.� <br /> Crl.m dL�L Rnm,a-Hcn�wn�M�Mi Inc.eu. <br /> .na' n�i-�en.rrc,ml•mm a..US <br /> Sigr.ature of Owner/Contractor/Authori=ea Agani����s�"-�ass�a.ro� Date <br />