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, <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8310— FAX 425-257-8857—vv�vw.everetlwa.org <br /> APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Q—I'Z —1,3 <br /> SITE ADDFESS PARCEL TAX I.D.# PERMIT# <br /> 1215 RUCKER AVE 40409422700800 �i '%��- , 1 i'� <br /> LECsAL l0T NO. 6LOCK TRACT <br /> DESC <br /> OWNER ADDRESS CIT'21P PHONE <br /> BILL LOESCHE 1215 RUCKER AVE Everett98201 425-750-8924 <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> Jennifer Burgess 206-774-9499 <br /> CONTRAC?OR \A/ESCO AD�RESS aTMN,oa 9eose Pg00-39B-4663 <br /> �� 3909 196 St SW, <br /> CONTR.LICENSE k WASHIES97�OB <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF V✓ORK <br /> Residential _e�e�c��� �Gas_Cther 950 <br /> WORI< DESCRIPTION <br /> iNSTALL 50 GALLON GAS WATER HEATER <br /> — PLUMBING MECHANICAL <br /> NO. TYPEOFFI%TUREORITEM NO. NPEOFF�XTUREORITEM <br /> Toilet _ A/C —air hantlling units <br /> BathWU Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower i Water heater <br /> Kitcnen sink E tlisposal _ Gas tueplace <br /> Dishv.asher _ Gas range <br /> Clolhes washer Gothes dryer <br /> Laundry tray _ Range hooa <br /> Sink(service/bar/mop/etc.) _ E*haustlan <br /> Backflowpreventer _ Heatpump <br /> Urmal Unit heater <br /> Drmking Fountam _ 8oiler <br /> Floor drain Rr,lrigereLon <br /> Grease trep _ Wootlsto+e <br /> Roof tlrains Other <br /> Other <br /> CIT'OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereUy certtify that I have read and examined this application and hnow the same to be true antl correct AI� provisions ot lavs and <br /> ordinaces goveming this type of work v.�ll Ue mmplied wilh whelher specrtied herein or not.The granting ol a permrt does no!presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating mnstruction or the pertormance of <br /> construction. That I am authorized Uy the cwner of this propaty[o pertorm Ihe vrork for whkh apphca[ion is matle and I comply wiih the <br /> State Contractors Law 18.27 RCW antl 296�200 WA0 F,,, n, 3nt <br /> J en n ife r B u r ess �,,�„,�,,,���,,,�.,.. �r:,�„�„s�,t��.�,.�„_,<�.,,.,..�sr <br /> 1'I Wfl�.�m91y^,nnn.•••wTnmC<am o:US <br /> Sianature o1 Owne�/Contracto Authon�ad � n��� � � �''� ' Date <br />