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NERMIT APPLICATION 3s�f� <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 // —C`�6 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> 2705 Riverview Blvd ooso370000s3oo UC� � I-CU � <br /> LEGAL LOTNO. BLOCK TRAC7 <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> Bryan Brockman 2705 Riverview Blvd e�a�en sezos 425-355-3431 <br /> TENANT NAME CON7ACT FOR PERMIT PHONE <br /> IMelissa Croda 360-945-2787 <br /> CONTRACTOR �A/FSCO AODRESS CITYIZIP PHONE <br /> VV 2800 Thorrzdyke SEATTLE 206-378-6649 <br /> CONTR.LICENSE M�VAS H I ES971 OB <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR Elnctric �If� Gas Other I 950.00 <br /> WORK DESCRIPTION <br /> Replace Gas to gas 50 gallon water heater <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FI%NRE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forced air systoms <br /> _ I.avatory(wash basin) Gas piping <br /> _ Shower � Water healer <br /> _ Kitchen sink&disposal Gas fireplace <br /> __ Dishwashor Gasrange <br /> _ Cbthes washor Clothes drycr <br /> _ lnundry tray Ranga hood <br /> Sink(service/badmop!etc.) Exhaust fan <br /> _ Backflow prevenfer Heat pump <br /> _ Urinal Unit heatcr <br /> _ Drinking Fountain �oiler <br /> ___ Floordrain Refri�eration <br /> __ Greaseirap Woods�ove <br /> _ Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined ttiis applicalion and know iha sam¢to bo Wo nnd correct. All provisions of laws and <br /> ordinac^s governing this lypa of work will be complied with whether spocfiod herein or nol The granting of a pemiit doos not presume <br /> to give authority to violate or cancel the provision of any other statr or local law mgulating conshuclion or the poRortnanco of <br /> conslrudion.Thal I am aulhorized by the owner of Ihis property to peAorm the work(or which application is mado and I comply with iho <br /> Stalc Contraclors Law 1827 RCW and 296.200 WAC. <br /> i <br /> i� d���G'� ��� <br /> Signaturo of OwnedContractor/Aulhonze Agoni ato <br /> L — <br />