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To: E Page 4 of 8 2016-01-19 21:59:52(GMT) 18884000383 From: Deborah Shields <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 5028 DOVER ST 00733800001100 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> KELLEY SMITH 5028 DOVER ST Everett98203 425-931-2951 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CUaida Khan 380--945-2787 <br /> CONTRACTOR Washington Energy Svcs Co, LLC ADDRESS CITYIZIP PHONE <br /> 3909 196th St SW Lynnwood 800-398-4663 <br /> CONTR.LICENSE#WASH <br /> SHIE 851 NS <br /> USE OF BUILDING V t 1 HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR _Electric Gas—Other 5743.80 <br /> WORK DESCRIPTION <br /> INSTALL GAS FIREPLACE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal 1 Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Con q4A?, :,: and 29E:2n <br /> ;..,;: , iSTctsfed.L,yJennifer Covello <br /> DN:c'n=Jennifer Covello,o,cw, <br /> ". a '.• email_'ern�rifeamnAt ermlt.rom,c:=US <br /> ...-aur,:: _ ,iF:%,� V <br /> Signature oY�">T zr;' izi=� t thorize A t "' Date <br />