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PERMIT APPLICATlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FA+. 425-257-8857—wwnv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /� --/3 —�� <br /> SITE ADDRESS PARCEL TA'� '.D. # pERM1T# <br /> 4927 23rd Ave W 00644500oo23u0 ��j� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> ON7JER A�DRESS pN21P PHONE <br /> Mike Goza 4927 23rd Ave W Everet198201 4253475365 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Jennifer Covello 206-774-9499 <br /> CONTRACTOR \A/ESCO ADDRESS qTY21P PHONE <br /> �� /� 3909 196 St S W, 800-398-4663 <br /> lynnwootl 98036 <br /> CONTR. LICENSE#�A/ASHIES.7! �OB <br /> \/V <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> RES __E�ectric � cas__other 1806.10 � <br /> WORK DESCRIPTION <br /> REPLACE GAS WATER HEATER <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM11 NO. TVPE OF FIXTURE OR ITEM <br /> _ Tcilet A/C-air handling units <br /> _� Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower i Water heater <br /> Kitchen sink& disposal Gas fireplace <br /> _ ^�shwasher Gas range <br /> _ Clothes washer Cbthes dryer <br /> _ Laundry lray Range hood <br /> Sink (service/badmop/etc.) Exhaust fan <br /> _ Backllow preventer Heat pump <br /> _ Urinal Unit heater <br /> � Unnking Fountain Boiler <br /> _ Floor drain Refngerahon <br /> Grease irap Woodslwc <br /> Roof tlrains Other <br /> Olher — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this applicafion and know the same to be trce and correcL �II prwisions oi lavr and <br /> ordmaces goveming this type of vrork will be mmplied with .vhether spealied herein or noL The grenhng of a permit Uoes not presume <br /> to give authority to violate or cancel ihe provision ol any other state or local law regulating mnstr¢ction or lhe peAormance oi <br /> construction. That I am authonzed by Ihe ovvner of ihls property to petTarm the vrork�or whch appllcation is made and I comply wRh the <br /> S4�te Contractors Law 18.27 RCW and 296 200 WAC. <br /> rna�u1N Uanrel W Imnun Hn�pn� <br /> Jennifer Bur ��� �"�i4ennfnYwqc�t�-I�WIINASIffflMll,au-IU'IIf.N51 <br /> �9 wnn......n.�nn�unu.�n����i��nm o-u5 <br /> Signature of OwnedComracto Authorixd�j'e�t'�"""�'��paje-- <br />