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To: City of Everett Page 2 of 3 2015-03-21 02:04:17 (GMT) 18884000383 From: Deborah Shields <br />SlTE ADDRESS <br />709 91 st PI SE <br />LEGAL LOT NO. <br />DESC. <br />� <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 />PARCEL TAX I.D. # <br />00605900001100 <br />BLOCK TRACT <br />ADDRESS <br />PERMIT # <br />� ��� 3- � <br />PWONE <br />Beverly Wellen/ Loretta Toole 709 91 st PI SE Everett 98208 425-879-2018 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Naida Khan 360-945-2787 <br />CONTRACTOR HOIlIE D@pOt At H0171@ S@I"VIC@S ADDRESS CITY/Z3P PHONE <br />140 County Line Rd, #101 PACIFIC 800-381-5699 <br />CONTR.IICENSE# H�MED�*972RQ <br />USE OF BUIL.DWG <br />SFR <br />WORK DESCRIPTION <br />HEAT SOURCE <br />Electric Gas Other <br />CONTRACT PRICE OF WORK <br />$12,000 <br />REPLACE 20 SQUARES OF COMPOSITE ROOFING; REPLACE 3 SHEETS PLYWOOD <br />Business license number: 042478 <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />6ackflow preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />MECHANICAL <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 />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CIFY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriiify that i have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br />ordinaces governing this type of work will be compiied 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 1 am authorized by the owner of this property to perform the work for which application is made and 1 compiy with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Kathleen Genge °'°"°'""°"""'"°`°k`°"°p` <br />..�. nN: o,-� mkc� ac�,pc, o-Norto-n,cn Pcrmu me, ou eman•xmarn„ocrmu.eo�n o-us <br />bm�: ic u.c�.zc �a:szac c rcr <br />Signature of OwnedContractor/Authorized Agent Date <br />