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To: E Page 5 of 7 2016-01-09 21:14:22 (GMT) 18884000383 From: Deborah Shields <br />• <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 Q— FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />171 � RUCKER AVE� � <br />LEGAL LOT NO, BLOCK <br />DESC. <br />)WNER <br />MARPANNE R{CE <br />TENANT NAME <br />PARCEL TAX I.D. # <br />0043803440.2�00 <br />TRACT <br />1718 RUCKER 1-�VE <br />CONTACT FOR PERMIT <br />Naida Khan <br />CONTRACTOR �aSIlIC1 tc�n Ener ��' ADDRESS <br />� yy ,�v�s c��: ��c� 3909 196th St SW <br />CONTR.LICENSE# 1nJh��rE�4�,� R�� <br />Y�1� U IV <br />USE OF BUILDING <br />�F� <br />WORK DESCRIPTION <br />REPLAGE GA5 VlIATEft HEAT�R. <br />NO <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (w�sh basin) <br />5hower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/�ar/mop/etc.) <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 />2MIT # <br />11a��1' <br />CITY/ZIP PHONE <br />Everett 650-924-8058 <br />PHONE <br />3�0-945-27�37 <br />CITY/ZIP PHONE <br />Lynnwood 800-398-4663 <br />CONTRACT PRICE OF WQRK <br />�:�.� ����j � °�'� <br />MECNANICAL <br />TYPE OF FIXTURE OR ITEM <br />A!C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />�� Range hood <br />�, Exha�st fan <br />, Heat pump <br />' Unit heater <br />' Boiler <br />Refrigeration <br />Woodstave <br />Other <br />CITY OF EVERETT LdCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applic�lion and know the same to be true and correct. All provisions of laws and <br />ordinaces goveminy 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 tha work for which appiication is made and I comply with the <br />Sfat2 COIILf"�„r �= i a'':2fld 296.Z�di, i�,�'sictr,edbyJei�ni`erCovel!o <br />���;i �� � �N: cn=1enr,'��(er Cnve'lo, o, ou, e'rc Y,I--ienni(er��,nwpermftcom, <br />� .: ` � r �y z- � w/t'�"' ��-c ..US <br />v, r6 �.�yl: � <br />' ' _•.. ..�.. = �a C �w � rrtn��nia n �� Q4 P OidS -�����. <br />re oi`vwiiein.unu��iuriNUihorized Agent Date <br />