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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />.3200 CEDAR STREET, EVERETT, WA 98201 <br />425-'157-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5 0� -Day <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />I PERMIT # <br />2129 MADISON ST <br />00544700503200 <br />b 5 10215 <br />LEGAL LO7 N0. <br />BLOCK <br />TRACT <br />oEsc. <br />0Wf1ER ADDRESS CITYMP PHONE <br />TERRY STITHEM 2129 MADISON ST EVERE7T, 692J3 425-314-5396 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Naida Khan 360-945-2787 <br />CONTRACTOR WESCO ADDRESS CITY2IP PHONE <br />2800 Thomdyke SEATTLE 206-378-6649 <br />CONTR. LICENSE! WASHIES97106 <br />_ <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />S FR I <br />_ Electric 3 Gas —other <br />1950.00 <br />NORK DESCRIPTION <br />REPLACE 50 GALLON GAS TO GAS WATER HFATER <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />. _ <br />A/C — air handling units <br />— <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas Pioiro <br />_ <br />Shower <br />I t <br />— <br />Water heater <br />_ <br />Kitchen sink & disposal <br />^_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Laundry!ray <br />i <br />Range hood <br />_ <br />Sink (servicalbar/mop/etc.) <br />__ <br />Exhaust fan <br />_ <br />Backtlowprevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />_ <br />Refrigeration <br />L <br />Grease trap <br />!_ <br />Woodstove <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL $ALES T/ X CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinaecs governing thirr type of work will be comySed with vditether specified herein or noL 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 construction 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 Contragfojhe Lsw�10.27 . W and 208.200 WAC. ` �J <br />� <br />/ l..' IN &.l'/__ `J l <br />Signature of Owner/Co nr1A1j1hnn7pd Anent oat <br />