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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT, WA 9E201 <br />425-257-8810 —FAX 425-257-8857 — �+nvw.everetriva.olg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. if PERMIT # <br />1916 MCDOUGALL AVE 00437938402400 M � 310`02-1- <br />_ <br />LEGAL LOT NO. BLOCK TRACT <br />CE"C <br />OWNER ADDRESS ❑T\'I21P PHONE <br />CORNELIUS A CUMMINGS 1916 MCDOUGALL AVE Everett 9U201 425-259-4528 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Jennifer Covello 206-774-9499 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />WESCO <br />3909 196 Si SW, Lynnwood 98036 800-398-4663 <br />CONTR. LICENSE d WA.SHIF_S971 OB <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />RES <br />_Electric �Gas_Other <br />5750.00 <br />WORK DESCRIPTION <br />REPLACE 40 GAL GAS WATER HEATER <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A!C—alrhandling units <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />Gas piping <br />_ <br />Shower <br />r <br />Water heater <br />Kitchen sink &disposal <br />Gas fireplace <br />_ <br />Dishwasher <br />Gas range <br />_ <br />washer <br />Clothes dryer <br />_Clothes <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Backflow, preventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstwe <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity 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 total 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 />D191•JN 4pixOW InmXe Bur9m <br />ON. crhiervi�n Bur9ni u•NORTIMLSi rwnn, w�110Bi1MLSi <br />Jennifer Burgess <br />�rMrB.�„Bi�B,�„��,�NS JoINIJj <br />Signature of Owner/Contracto rAutnorixd A�n •'"r"�"'"f9° Lia[e �— <br />