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06/16/1.010 WED 11: 42 PAX 425 487 6524 Nortcreek Raof in 0002/002 <br /> i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257.8810-FAX 425-257-8857-www.everettwe.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 -lb —IV <br /> SITEADDRESS PARCEL TAX I.D.NI � OI-7ERMIT N _ <br /> 2631 57th Street SW 11LdM11/C_I <br /> j LEGAL LOT NO. BLOCK TRACTOR SUBDIVISION <br /> lit,bo <br /> ADDRESSOWIlili RIP PONE <br /> Bob Olsen 2631 57th Street Sw, Everett 9823 425-349-2000 <br /> TENANT NAMEI CONTACT FOR PERMIT PHONE 425-483-7989'— <br /> Pam Stairs EMAIL yenwnurcncreekr(ME;I'.uvu <br /> CONTRACTOR or res - oo ng —CITS'>ZIP —pTfGRr- <br /> 17624 15711 AVE BE, 4105A, BOTHELL 98012 425-483-7986 <br /> CONTMLICENSENNORTHCRO42172 <br /> USE OF DUILDINO ( HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Electric _Gas_Other I $22, 150.00 <br /> WORK DESCRIPTION <br /> Tear off existing shake roofing, install 1/2" CDX plywood over existing <br /> skip sheeting and new composition roofing shingles. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unite <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower — Water healer <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> _ Dlehwoshor Gas ranpo <br /> Clothes washer Clothes dryor <br /> _ Wale-hoolor _ Range hood <br /> -,_ Sink(servlco/badmop/etc.) Exhaust fon ' <br /> Backilow prevenler 11001 pump <br /> Urinal Unit healer <br /> Drinking Fountain ,_ Dollar <br /> Floor drain Refrigeration <br /> — Grease trap Woudslove <br /> _. Roof drains _ Osler <br /> Other <br /> r CITY OF EVERETT LOCAL BALES TAX CODE IS 3706 - <br /> I hereby coftify that I Ineve road and ezaminod this application and know the same to be true and cofrocl. All provisions of lows and <br /> ordlnaneea governing Inde typo of work will be compiled with wholhor specified heroin or not.The granting of a permit does not presumo <br /> to give authority to vlolalo or cancel the provision of ony other stele or local law regulating construction or the performanco of <br /> construction.That I am authorized by tho ownor of this property to porform the work for which application Is made and I comply with the <br /> Slate C n roclors La 18. .7 RCW and 2g0.200 WAC. <br /> am :a.b�-t-"�r 6 116 <br /> Signature of Owner con rac a uI or ze g0��' Date �� <br />