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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> q25-257-8810— FAX 42r257-8857—ovww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4°M I-- � �1 � <br /> SITE ADDRESS I PARCEL TAK I.D.N PERMIT M <br /> 2928 107TH ST SE <br /> U0868300201400 (Yl I ;�("�1 ' �-�r� <br /> LK+4L LOTNO. BIOCH� TRACT <br /> DGSC — <br /> OWNER ADDRESS CITVRIP PHONE <br /> JULIE REIMAN samc as site �ddress 98208 425-338-1393 <br /> TtNANTNAME CONTACTfORPERMIT PMONE <br /> Cyn,ial/Naida 360-945-2787 <br /> CONTRACTOR \A/ESCO A�ORESS dTY21P PHONE <br /> �� 2800 Thorndyke SEA�I'TLE 500-398-4663 <br /> CONTR. LICENSE q WAS H I ES97 1 ,JB <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Residential _E�e����� � ��5_o�^e� � 2250.31 _ <br /> WOR{< DESCRIPTION <br /> REPLACE GAS 60K BTU FURNACE <br /> --- PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tollet A/C—alr handhng units <br /> BathtuU + Forced au systems <br /> Lavatory (evash basin� _ Gas piping <br /> Shower _ W�ter heater <br /> Kttchen sink 8 d�sposal _ Qas lueplace <br /> Dishwasher _, Gas renge <br /> Cblhes washer Clothes aryer <br /> Laundry lray _ Range hood <br /> Sink (sernce/bar/mop/etc) _ E•hauslfan <br /> Backflowpreventer _ Heatpump <br /> Urinal _ Unil heater <br /> Unnhmg Fountain _ Boiier <br /> Floor drain _ Rafrigeret�on <br /> 3rease trap _ Woodstove <br /> Roof tlrains _ Other <br /> Other __ — <br /> CIN OF EVERETT LOCAL SALES TAJ(CODE IS 7105 <br /> I hereby cerility lhal I have read and exammed Uvs apphcation and hnowlhe same to oe true an0 correct All prwisions of laws and <br /> orcfinaces govermng this type o1 worh wUi be complied vnth whether specihetl herem or not fhe granhng of a perrrut does not presume <br /> to grve authonly to violete or cancel the prons�on ol any other state or local law regulating mnstruction or the pedormance of <br /> cur,gtruclion That 1 em authonzed by the owner ol lhis property to perfe�m the worh for whkh apphcation is matle and I compiy wRh the <br /> �tate Contracrors Law 7P 27 RCW and 296 200 WAC <br /> ,_ '_ _ 01/18/2012 <br /> Signature o wner �ontracror ut onze gent ate <br />