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To: Permit Services Page 2 of 4 2016-02-17 18:27:03 (GMT) 18884000383 From: Deborah Shields <br />SITE ADDRESS <br />202 60th P! SE <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />Rick Bergmans <br />TENANT NAME <br />`J <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-2�7-8857 — www.everettwa.org <br />RPPLiCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.Q. # <br />007��� 0000�t� oa <br />BLOCK TRACT <br />202 60th PI SE <br />CdNTACT FOR PERMIT <br />Naida Khan <br />W <br />CITY/ZIP PHONE <br />Everett �a2o3 425-347-19'16 <br />PHONE <br />360-945-2787 <br />CONTRACTOR Hame De�ot �it Horne Services ADDRE55 GITYlZIP PHONE <br />1�0 Cou�ty Lirie Rd, #101 PACIFfG aoa-�a�-�sg� <br />CONTR.LICENSE# ���g��,������� <br />IVf <br />USE OF BUILbING <br />SFR <br />WORK DESCRIPTION <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />$1�,313.1�1 <br />REPL�CE 22 �QU/aF�ES OF CC�MPOSITE �OO�fNG; NO PLYt�tlC?CJD F��PLA�EMENT. <br />NO. <br />PLUMBING <br />TYPE C1F FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />5hower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />5ink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <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 handliny units <br />Forced air systerns <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 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 yoveming 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 perforrnance of <br />construction. That I am authorized by the owner of this prope�ty to perform the work for which application is made and I comply with the <br />5tate Contractors Law 18.27 RCW and 296.200 WAC. <br />� { � /! '. Dinitalhi a�i3i;et1 Ly �tiaica K���en <br />� ^� � fY ^\ 9Q Y'! ""t � C:I•i:ai=NaidaKl��an,u=A:orthn�>IF�rrii; <br />,r , i e t-1 ��� e r•� <br />Signature o wner/ on rac or �u�ac�;fz� z/�1gg��t�--c:ao, Date <br />