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To E Page 2 of 3 ?C14-08�06 21 A035 (GM� 1880a000383 From� Deborah Shicids <br /> __ _ _'�__ .._— -- _____ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-867 0- PAX 425-257-8857 -www.everellwa.org I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I' <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 4826 DELAWARE AVE 004�02000�Oa00 �l�( ( Q`h-pl� <br /> LEGAL LOT N0. BLOCH TRACT <br /> DESC <br /> OWNER � AODRESS CITYILP PNONE <br /> WILLIAM S RANDOLPH 4826 DELAWARE AVE e�erett ge2o3 425-314-0826 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> JENNIFER COVELLO 206-774-9499 <br /> � <br /> CONTRACTOR \A/ESCO ADDRESS qTY/21P PHONE I <br /> °V �1 .1 3909 196th St SW Lynnwood 800-398-4663 <br /> CONTR, LICENSEx WASHIES.77 I OB <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> RES _E!ectnc �Gas_otner 7$2$,60 <br /> WORK DESCRIPTION <br /> INSTALL OIL TO GAS 80K FURNACE WITH 60' NEW GAS PIPING <br /> � <br /> � <br /> PLUMBING MECHANICAL � <br /> NO. I TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEId � <br /> _ Todet NC–a�rhandun9un�ts <br /> Bathtub + Forced a�r systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater i <br /> K�tchen sinF:8 tl�sposal Gas fireplacc <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry Irey Range hood <br /> Sink (survice/borlm�p�etcJ � Exhausl fan <br /> DackAow preventer Heat pump <br /> Urina� Unit heater <br /> Dnnking FouNain poiler <br /> Floor drain Reingcrahon <br /> Grease trap Woodstove <br /> Roof drains _ Other � <br /> Othcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cenlify that I have read and examined this appiica6on and know the same to be true and cortect All provisions ot laws and <br /> ordinaces govemmg this type of work will be complied with whether speahed herein or not The granhng ot a permil does not presume <br /> to give�uthority to violate or cancel the provlsion o(any other state or local law regulatmg consVuchon or the performance of <br /> construcbon. That I am authorized by lhe owner of thls property to periorm the work for which appllcation is made and 1 comply w�U�the <br /> Stale Coniractors law 1827 RCW and 29f�7,QQ�!y�E��,,,,,�,<a�,W <br /> Jennifer Covello °,�mA°�.°��°,��"°-,:a�°-�°`°T,��°°°° <br /> �,.� �,<<.,,,a,� .,�, <br /> �)�I�l�M 1�\9)J li)M' <br /> SignaWre of Owner/Coniraclor/Authonied Agent Oate <br />