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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.evere11W3.o19 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX LD. # <br />PERMIT 0 <br />4216 S 3RD AVE <br />00500400800800 <br />Q — 04 <br />LEGAL LOT NO. <br />BLOCK <br />TRACI' <br />DESC <br />OWNER ADDRESS CITYlZIP PHONE <br />DENNIS G GUISASOLA 4216 S 3RD AVE Everett 98201 425-773-0114 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Jennifer Covello 206-774-9499 <br />CONTRACTOR \A/ESCO ADDRESS CITY0P PHONE <br />VV 3909 196 St SW, Lynnwood 98036 800-398-4663 <br />CONTR. LICENSE d WASH IES9.71 OB <br />USE OF BUILDING— HEAT SOURCE CONTRACT PRICE OF WORK <br />RES _Electric V—(Gas —Other $950.00 <br />I — <br />— <br />WORK DESCRIPTION <br />REPLACE 50 GAL GAS WATER HEATER <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />Toilet <br />A/C — au handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />r <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />_ <br />Sink(service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Greasetrap <br />Woodstove <br />Root drains <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerflify that I have read and examined this application and know the same to be true aA correct. All provisions of laws and <br />ordinates governing this type of work wall be complied with whether speoheo 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 taw 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 Wow <br />mmtn emye, <br />VA% 11A <br />Jennifer Burcciess n o-r mrwa ro•n-uc.mnnsrn nwr au.rxwnNnt <br />r'I nva, emn�.,mniiwm+wnnm, <br />Signature of Ownet/Contracto Autlaon.etl en """ Date <br />