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T�� G PSY^ �r�117 ]O�<.OI.fI) �O d\ lIl1AMT1 �NI�I\nO00JI�] �'.��r�. pn��.�r�r. �:�..�i.�n <br /> �_______ _ . .• . _ . _. <br /> PERMIT ArPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT p <br /> 5112 ALTA DR 1 003�750oo02i00 �1t.�0 � 'd <br /> LE;AL LOT NO. BLOCN TRACT <br /> OESL r 1_ __ <br /> OWNEF ADDRESS CITVIZ�P PMONE <br /> JOHh' MOIR 5112 AI_TA DR Everelt 98203 425-259-6826 <br /> TENANT'AAME CONTACTFORPEHMIT PHONE <br /> Jennifer Covello 206-774-9499 <br /> CONTRACTOR �A�ESCO ADOHESS CITYIZIV PHONE <br /> V V 3909 196th St SW Lynnwood 800-398-46fi3 <br /> CONTR. UCENSE�WASHI ES971 OB <br /> USE OF BUIIDI'IG HEAT SOURCE CONTRACT PRICE OF WORK <br /> RES _ Elecmc �Gas_Otner $5pg2 � <br /> WORK DESCRIPTION <br /> REPLACE 80K GAS FURNACE <br /> PLUMBING MECHANICAL <br /> N0. I TVPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel WC-air han�'hng units <br /> Aathtub + Forced av systems <br /> Lavatory(wash bas�n) Gas p�pmg <br /> Shower Water healer <br /> K�tChen sink 8 tlisposal _ Gas fireplace <br /> _ Dishwa,her _ Gas range <br /> Clothes w�5her Clolhes drycr <br /> Laundry iray Range hood <br /> S�nk(sernccibadmop/etc ) E�h�usl lan <br /> _ Backllow prevenlcr Heat pump <br /> Urmy Und healer <br /> Dunking Fountain Doller <br /> Floor dra�n ReingcraUon <br /> Grease Uap _ Woodstovc <br /> Rool drein, Othor <br /> -�--- Other — —.... . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�f05 <br /> I hereby cerNfy thal 1 have read and^.amined this apDGcabon and hnaw the same lo be Irue antl correct All provisrons ol laws and <br /> ortlmaces govemv�g tlus ty0e ol work w�ll be compl�ed wrth whelher,pecdied herem or nol The graNiny of a permd does not presume <br /> to glve authordy to violale oi cancel Ihe provision ol any other state or local law reguiatmg construclion or the peAormance ol <br /> construcuon That I am;uthonzed by Iho owner ol t�is Droperty to pertorm Ihe woik tor which aDOhwbon is made and I comply wdh the <br /> State Comractors law te?7 RCVJ and 29��AO wlUC <br /> q ��q�.d IrnrdnCo.rAe <br /> Jennifer Covello DMu�-inm.�w(o.rluu-Nn��..�ih•mnin�ewPq.a��i <br /> ♦6punluyuyr�mJb�n�nln�nnM�m�;aom a�Ut <br /> S�gnature o wnedConlraclouAuthonietl��'n�°""�" Date <br />