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� �- <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.orp <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L,/�/ �� <br /> / <br /> SITE ADDRE55 PARCEL TAX I.D.• PERMIT rt <br /> � 105 COLBY AVE ooa6862200�300 //0��.� <br /> LEG4L LOT NO. BLOCK TRACT <br /> DEuC. I <br /> OWNER ADDRE55 QTY2IP PMONE <br /> RICK HOEKENDORM SAME AS SITE ADDRESSS EverettsB2o� 425-252-6919 <br /> TENPNTNAME CONTACTFORPERMIT PMONE <br /> ICyndal/Naida 360-945-2787 <br /> CONTRACTOR 1A/ESCO ��RE58 OTV21P PHONE <br /> YY 2800 Thorndyke SEATTLE 800-398-4663 <br /> coHne.uceNse«WASH I ES971 OB <br /> USE OF BU�LDING I + HEAT SOURCE I CONTRACT PRICE OP WORK <br /> residential Electric �Gas_Other 9rjQ.QQ <br /> WORK DESCRIPTION <br /> FEPLACE GAS 50 GALLON HOT WATER HEATER <br /> PLUMBINd MECHANICAL <br /> N0. TYPE OF flXTURt OR ITEM NO. TYPE OF flxTURE OR ITEM <br /> Toilet A/C—alr hantlling untts <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kttchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Glothes vrasher Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicefbar/m�p/etc.) _ Ezhausttan <br /> Backflow preventer _ Heat pump <br /> Urinal Untt heater <br /> _ Drinking Fountain Boller <br /> Floor drain Refrigeratbn <br /> Grease trap _ Woodstwe <br /> Roof dtafns Other <br /> Other <br /> _ —f • <br /> dTV OF EVERETT LOCAL SALES TAX COuE 18 J705 <br /> I heieby certtify that i have read and ezamined this application and know the same to be true and correct. All pralslons of Wwa and <br /> o�dinaces governing thlstype oi work will be complieC with whether specified herein or not.The granting ot a pemYt does not presume <br /> to give authority to violate or cancel the provision of any other state a local law regulating con�tructlon or the pertormance of <br /> construclion. That I am authorized by the owner of thfs property to pertorm the vrork tor whth application Is maEe and I comply wtth the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> '- - 9/19/11 <br /> Signature o ner/ oMrector/ uthorize gent ate <br />