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� <br /> PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CCDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810—FAX 425257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � 'IS�� <br /> SITE ADDRESS PARCE4 TN(I,O,# PERMIT M <br /> 3634 EVERETT AVE 00562564401500 ��j _ i <br /> ' LEGAL LOTNO. 6LOCK TRACT <br /> DE90. <br /> OWHER ADDRESS cITY/AP PHONE <br /> RUBATINO REFUSE 3634 EVERETT AVC Eveielt sezot 425 258-23$9 <br /> TENANT NAME GONTACT FOR PERMIT PHONE <br /> INaida Khan 360-945-2787 <br /> CONTttoCTOR 1A/ES,�•O ADDRESS CITYTP PNONE <br /> �� .1 2800 Thorndyke SEATTLE 800-398-46�3 <br /> CONTR.LICENSE 7,^'A5 H I ES�7 I O B <br /> VV <br /> usE of auILDINc HGAT SOURCE CONTRACT PRICE OF WORK <br /> SFR _Eledric �,Gas_Other $750.00 <br /> WORN DESCRIP710N <br /> REPLACE 40 GALLON GA5 WAT[R HEATER <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIIRE OR ITEM N0. TYPE Of FIXTURE OR ITEM <br /> _ Toilet A/G—airhandlin0units <br /> _ 8nthtub Forcx±dnirsystems <br /> Lavalory(wash basin) _ Gas pipinp <br /> ` Shower i Wnterheater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher � Gas range <br /> _ Ciothes wasner _ Clolhes dryer <br /> � Laundry fr�y Rnnge hood <br /> Sink(service/bar/mop/otc.) Exhaust tan <br /> Oacl:fluv,pravenkr Mnul punip <br /> ,_ Urinai Unit heater <br /> Dnnking Founlain Boiter <br /> _ floor drain � Rcfrigcration <br /> Grr.ase trap WOodStove <br /> � RooFdrains —' Other <br /> — oinP� — <br /> CITY OF EVERETT LOCAL SALHS TA%CODE IS 5106 <br /> I hemby centiy ihat I have reod and examined Ihis appiication and know the same to be trve ond correct, All provisions of lews end <br /> ordineccs govcming this type ofwurk will lie complied with whether apeu�eJ heicin ui nW.tiw yianW�y uf a prnnd does n�t piewme <br /> to give authonty to violate or cancel the provision of any other state or local law regulating anstruction or the performance oi <br /> consttudion.Thal I am nuthorized by the ownerotthis propeRy fo pedortn ihe work fo�which application is matle and I rnmply with the <br /> Stato CeMra ore l0 27 RCW�nd�06.200 WAC, <br /> (S ( c� <br /> ienature ot o n ontractorfAuthonzed Apent na�� <br />