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To: E Page 4 of 7 2016-01-04 15:46:47 (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 <br />2632 RUCKER AVE <br />�EGAI LOT NO. BLOCK <br />DESC. <br />PARCEL TAX I.D. # <br />OQ4391615016QQ <br />TRACT <br />PER T # <br />�i���)I-����., <br />QWNER ADDRESS CiTY(ZIP PHONE <br />MADR4NA ASSOC I{ LLC 2632 RUCKER AVE Everett �€�5-319-1555 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />l�alc�a Khaii J��-���-2187 <br />CONTRACTOR ADDRESS GTY/ZIP PHONE <br />Washir�c�ton Ener�y Sv� s Co, LLC <br />��a� � ��tn s� svv ��n��oo� 8t�0-398-46�i3 <br />CONTR. LICENSE #� A/AS�1 E�(?�,3� { V� <br />\/ V <br />USE OF BUILDING <br />COhAiNERCIA� - IVIULTIF.AM P�CT�. <br />WOFZKDESCRIPTION <br />REPLACE GAS WATER HEATER. <br />NO. <br />PLUMBING <br />TYPE OF FiXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory {wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwashar <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />_ Electric ]� Gas _ Other <br />NO. <br />8 <br />CONTRACT PRICE OF WORK <br />s�ii1 <br />MECHANICAL <br />TYPE OF FIXTURE OR tTENt <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />i Gas fireplace <br />I Gas range <br />�' Clothes dryer <br />I Range hood <br />' Exhaust fan <br />' Heat pump <br />Unit heater <br />Boiler <br />' Ref�igeration <br />Woodstove <br />Other <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and exainined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces 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 wark for which application is made and I comply with the <br />Stafe Contract,��� l aw 1 R?7�R,�W and 296.200 WAC <br />,j����J� ' o �� r,s� i� � -„� �.�.i� <br />��"' �^"' 4�t <<�'�•�'`'1"� � I>N n:=.!onM (. c.o.��,c�u.qmsli�.� nni�-�em,n_,p rm�it.<nn.e-U`_� <br />1h{ .,;x i�,(t�? - L h.1,i:16,( 1 �� "�Sl_7° �(1N'�C' <br />f7' / V 1 �J <br />