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03-04—'09 10:49 FROM— <br />T-357 P002/002 F-168 <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.everettwa.org <br />APP''LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 �/`-o <br />— — <br />SI-i E ADD 4ESS PARCEL TAX I.D. 0 PERMIT # <br />128042400200400 Oct <br />10110 EVERGREEN WAY r�io'� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />EMERALD CITY HEALTH CLUB 4210 184TH AVE SE Issaquah 08027 425-749-9887 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />aq Howl- Y��e� <br />INaida Khan/Northwest Permit Inc 360-945-2787 <br />CONTRACTOR `n ESCO ADDRESS CITYIZIP PHONE <br />1/1I l—J 2800 Thorndyke SEATTLE 800-398-4463 <br />CONTR. LICENSE Y WASH I ES971 OB <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />HEALTH CLUB <br />_Electric 3L, Gas —Other <br />$30,000.00 <br />WORK DESCRIPTION <br />REPLACE 3 COMMERCIAL PHOENIX WATER HEATERS. <br />LOCATION: ALL 3 ARE LOCATED IN UTILITY ROOM /BOILER ROOM OFF OF POCL ON SOUTH SIDE <br />OF BUILDING _ <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITF.IA NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />Forced air systems <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />— <br />Shower <br />3_ <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />—_ <br />Dishwasher <br />_ <br />Gas range <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 />Backllow preventer <br />Hea! pump <br />_ <br />Urinal <br />— <br />Unit heater <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified 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 law 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 />Stale Contractors Law 1 1 RCW and 296.200 WAG. <br />Signature of Owne L' tractor/Authorzed Agent Date <br />