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PERMIT APPLI�+4TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wvrN.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �- a� - �3 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 8916 5TH AVE W 28041300203500 � ° <br /> LEGAL LOT NO. BLOCK TRP.�T <br /> DESC � <br /> OWNER ADDRESS CIT/21P PHONE <br /> TONY BRAGG 8916 5TH AVE W Everetl 98204 425-238-8753 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> IJennifer F3urgess 206-774-9499 _ <br /> CONTRACTOR ADDRESS dNIZIP PHONE <br /> WE`SC'� 3909 196 St SW� Lynnwood 98036 $00-398-4663 <br /> CONTR.LICENSE u WASH I ES9/ � OB <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Residential �Electric _Gas_Oiher $3880 <br /> WORI( DESCRIPTION <br /> REPLACE 15KW ELEC FURNACE <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> l oilet A/C—air handling units <br /> BathtuU � Forced air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink E disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> laundry tray _ Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaustfan <br /> Backflow preventer __ Heal pump <br /> Urinal _ Unitheater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ kefrigeration <br /> Grease trap _, Woodstwe <br /> Roof tlrains _ Other _ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TFUC CODE IS 3105 <br /> I hereby ceri[ify that I have read and examined Ihis application and know the same to be true and correct. All prwisions of laws and <br /> ordinaces goveming this type of worh will be complied with whether specitied herein or not The grantiny of a permit does not presume <br /> to give authority to violate ur cancel ine provision of any other state or local law rec�ulating construction or the performance of <br /> construchon. TY�at I am authori=ed by the ovmer oi this property to perform the vrork for which apolication is made and I wmply with Ihe I <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> f I:JI�.PtI U�nee b/In�nllih Owgeu <br /> J e n n i f e r B u r e s s �:����„�r�,,,,,��,9<«� ,,��„�,�_,,,��,��.��,.,�,,,:,�5� <br /> Vt Iw11.ernnl.�inni4rF�,wl�nmhsam cus' <br /> Signature of Ov,�ner/Contracto Authoricad ' eti '� Gate <br />