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To: E Page 3 of 7 2015-12-16 18:28:19 (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.# -PE iJ�T,# � <br /> 4906 23RD AVE W 00644500000800 111���,/1b 11r1•7� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> DIANE FERGUSON 4906 23RD AVE W Everett 4253536213 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Maida Khan 360--945-2787 <br /> CONTRACTOR Washington Energy Svcs Co, LLC ADDRESS CITY/ZIP PHONE <br /> 3909 196th St SW Lynnwood 800-398-4663 <br /> CONTR.LICENSE# WASH I ES851 ly IS <br /> USE OF BUILDING 1 V HEAT SOURCE CONTRACT PRICE OF WORK <br /> 130 Multiple Family 5-7 Units _Electric V—/ Gas_Other 1799.64 <br /> WORK DESCRIPTION <br /> REPLACE. GAS WATER HEATER. <br /> LOCATION: BASEMENT <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 1 Water heater <br /> Kitchen sink&disposal 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 ceritify that I have read and examined 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 work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Digitally sgrect bylennifer Covello <br /> L'N:cn=Jemufert..oaello,o,ou,email-.ermlferr¢mwpermit.com,c=US <br /> Signature of t `, ,orized Agent m` to <br />