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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-SSSi—v✓vaw.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORE55 PARCEI TAX I.D. # PERMIT# <br /> 1416COLBYAVE 004753293024oU � a�a-o�s/ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC <br /> OWNER ADDRE55 QTY21P PHONE <br /> DANE SUMMERS 1416 COLBY AVE Everelt 98201 425-252-5910 <br /> TENPNT f7AIAE CONTACT FOR oERM1T PHONE <br /> Jennifer Burgess 206-774-9499 <br /> CONTRACTOR �A/ESCO �+DDRE55 ❑TYRIP PH04E <br /> VV 3909 196 St SW� LYnnwootl �eu�o 800-396-4663 <br /> �o"TR.u�E"SE"WASHIES971 OB <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Residential _E�e�t��� � Gas_Cther $750 <br /> WORh DESCRIPTION <br /> Replace 40 GAL GAS water heater <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEIvt <br /> _ Toilet A/C—airhantling umts <br /> _ 6athtub f-orced an systems <br /> _ Lavatory (e.ash basin) Gas piping <br /> Shovrer i Waterheoter <br /> Kitchen sink&alsposal Gas f�replace <br /> Dishwasher Gas range <br /> ClOtheS washef Cbthes dryer <br /> Laundry tray Range hood <br /> Snk(5ervicelbaUmop/etc.) Enhaustfan <br /> Dackflow preventer Heat pump <br /> Urmal Umt heater <br /> Drmkmg Founta�n Boiler <br /> _ Floor drain Reinge�abon <br /> _ Greasetrap Woodslwe <br /> Rooi tlrams Other <br /> Other <br /> CITV OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby centify that I have read and e.amined this application and hnow the same to be lrue antl correct. All prwisions of laws antl <br /> ordinaces governmg thls lype of work witl be comphetl with whelher specrfied herein or not. The yranLng ot a permd does not presume <br /> to give aumonty to violate or cancel the provision ot any other state or iocal iaw regulating consliuction or the pertormance o1 <br /> construcLon. Tha�I am authorized by the owne� of this �iroperty to perform the worh for whkh apolicat�on is made antl I comply wRh Ihe <br /> State Contraciors Law 18 :i RGW antl 296 200 WAG <br /> n��evp���,u rr r�,��uR w��y.�� <br /> Jennifer Buraess �,,...:.,,.,.,a�..�:.� ,,�,F,,,..,;,,,�..,,.�„-�k�,,,,,�sr <br /> lUwli .m�n-�+•r�InPMTnmr,,:mrUt <br /> S�gnature of OwneuContrecto Authon�aC��etl�'` ' Date <br />