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To Ciry of Everett Page 2 of 3 201 a�C6-17 22 2f3 i 7 (GMT) 18B8a000383 From� Debor.�h 9neids <br /> —._——__ �__—._—. --__—._ � _—.__ _ I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —Nnvw.everettwa.org <br /> APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 8111 E Glen Dr OOaa080oo00600 _��_ (p_ Q2(p <br /> LEG�L LOT N0. BLOCN TRACT <br /> OESC. <br /> OWNER A�DRE55 CITYILP PHONE <br /> ; Keith Goodall 8111 E Glen Dr Everetl98203 425-501-9004 <br /> � TENANT NAME CONTACT FOR PER�d1T PHONE <br /> INaida Khan 360-945-2787 <br /> CONTRACTOR H0010 DBpOI Al HORIB SeNIC@S ADDRESS CITYILP PHONE <br /> 140 County Line Rd, #101 PACIFIC 800-381-5699 <br /> CONTR. LICENSE: HOMED"972RQ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFfZ _Eiectac _Gas_Omer $10,380.35 <br /> WORK DESCRIPTION <br /> REPLACE 22.7 SQUARES OF COMPOSITE ROOFING <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEIA NO. TYPE OF FI%TURE OR ITEhi <br /> To�let A1C—air handling units <br /> Bathtub . Forcetl air systems <br /> Lavatory(wash basin) Gas pip�ng <br /> Shower Water healer <br /> K�tchen s�nk 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes drycr <br /> Laundry tray Range hood <br /> Sink(serviCC/bar/mopletc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Unnal Und heater <br /> Dnnking Founlain Boder <br /> Floor drain Re(rigerauon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAI SALES TA%CODE IS]f05 I <br /> 1 hereby centity(hal I have read and examined ihis application and know the same to be true and conect All provisions of laws and � <br /> ordmaces govemmg this type ol work vnll be compiied wrth whelher specified herein or not. The granUng of a permd tloes not presume <br /> to give authority to violate or cancel Ihe provision ot any olher stale or local law regulafing conshuction or the perlormance of <br /> conshudwn That I am authouzed by the awner of this property to periorm the work(or which application is made and I comply wnh�ha <br /> Slale CoMraclors Law 1827 RCW and 296 2C0 WAC. <br /> CtiqlLd�y�I�ned SY M1ethlran Gen 9t <br /> K�th_Leen Gena�D4�n=Ya:LlrenGcng^c,o^NonhwestGcimlt, — i <br /> D�lCm�n.L.L.. -ut � <br /> S�gnature of OwnedContracto� uth��d�EfiA9gNisss3�-mroo Date <br />