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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. R <br />PERMIT X <br />4704 Harbor Lane <br />00417100000802 <br />U 1 S <br />LEGA LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION f <br />DESC. 9 <br />[See attached Legal Description] <br />OWNER ADDRESS CITY(LIP PHONE <br />Rick & Holly Anderson 4704 Harbor Lane Everett 98201 <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE425.778.8500 <br />Same as owner <br />CIS Engineering robin c en ineerin com <br />g 9 g <br />Rohm Geveshausen E-MAIL <br />_ AUURE <br />CONTRACTOR <br />To be determined <br />CONTR. LICENSE • <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Single Family Residence <br />Electric Gas Other <br />S8,000 <br />WORK DESCRIPTION <br />Stabilize existing interior footings. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air handling units <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />Shower <br />Water heater <br />Kitchen sink & disposci <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/ele.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heat pump <br />Urinal <br />Unit healer <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />Grease trap <br />Woodslove <br />Roof drains <br />Other_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilily 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 not. 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 Contractors Law 18.27 RCW and 296.200 WAC. <br />lr.4Yn!i�C7�l2CrfrlJJ�i 1f(�i <br />Jam`{:✓•�f�-v�1l.n <br />Signature of OwnerlComraclor/Aulhonzed Agent , --�.r �51e /1Z <br />