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t <br />� <br />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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. p PERMIT # �, <br />505 SE Evareti" Mall Wa ZS-O5� $"°°'�' o48oe �p,{p��g� <br />LEGA LOTNO. BLOCK TRACT , <br />oes� g�� Qi1-a ed Parcel 6 Dcsc.r� �tion � <br />OWNER ADDRE55 GITYIZIP PHONE 42CJ �I <br />81oc.h 1'�opax�'its �-� �ogo� �"lain St, Sui+t,loo B�Ilcvuc, WA ,��.�y�o; <br />TENANTNAME <br />R�nt-A- Gen+c� <br />CONTACT FOR PERMIT <br />parr-.e.i'1 �loc,h <br />CONTRACTOR A�DRESS <br />CONTR.LICENSEq h0� YG�' sele�.t'e�I <br />USE OF OUILDING <br />Rzfio�i I <br />HEAT SOURCE <br />_ Electnc �Gas _ Other <br />PHONE <br />425 • 45 I • 3�oGa <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />+�2rj� c700 <br />WORK DESCRIPTION <br />M�nor De,rr�ol�tio�l Pa-4-c�iri cind re air, , <br />Less-t'han Sa�o 5.�F"t. of n� s�sp.`ndtd cuo�5'h� c��l�n5 <br />-t-o m atc.h e,Xi � n c� <br />NO. I TYPE OF FIX i URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory Iwash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cblhes washer <br />Laundry tray <br />Sink (servicelbarlmopletc ) <br />Backflow prevenler <br />Unnal <br />Onnking Fountam <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —air hantlling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gasrange <br />Clothes dryer <br />Rangehood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby centily Ihat I have read and examined this applicaUon and know Ihe same to be true and correcL All provlsions of laws and <br />ordinaces goveming this type of work will be complled with whelher specified herein or not. The granting ot a permit does not presume <br />to grve authonty lo v�ola!e or cancel Ihe provision of any other state or local law regulaling construclion or the performance ol <br />consirutlion Thai I am authorized by lhe owner ol this propeny to perlorm Ihe work for which application is made and I comply wi�h Ihe <br />$IatrCamractors Law �82i RCW and 2962W WAC <br />�� � <br />/-- / �- 7 ��� ��/ <br />