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PERMIT APPLICATION a <br />y <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88 10 — FAX 425-257.8857 — www everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />BE.RMIT # / <br />4911 Colby Ave <br />29053100402400 <br />LEGAIL LOT NO. <br />BLOCK <br />TRACT <br />DEC <br />OWNER ADDRESS CITyIZIP PHONE <br />Philip Cook 4911 Colby Ave Everett 98203 425-258-2283 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />(Melissa Croda 360-945-2787 <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />W <br />2800 Thorndyke SEATTLE 206-378-6649 <br />CONTR. LICENSE 0 AS <br />WAS HIES971 OB <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />SFR <br />I <br />— Electric ✓ Gas other <br />7896.00 <br />WORK DESCRIPTION <br />Replace 2 gas fireplace inserts, Lexington A142DVN & Lexington AI21 DVN and 20' gas <br />piping to fireplaces <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM. <br />_ <br />Toilet <br />A/C — air handling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />Clothes dryer <br />_ <br />tray <br />Range hood <br />_Laundry <br />_ <br />Sink (sorvice/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backilow, preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodslove <br />_ <br />Roof drains <br />Other— <br />Other - <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or rot. 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 constmclion or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />_� iiFGCiL� �� <br />ignature o er ontractor/ IMOnZod Agent ate <br />