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--- -------- - -- <br /> - -- ---- i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CLDAR S7REE'f, EVERET'I', WA 9820� <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y —Q/—�� <br /> SITE ADDRESS NARCEI TA%I.D,11 P RMIT tF <br /> 1021 Lombard Ave � /(70� �0/ <br /> I.FG�t LOT NO. �IOCIS TRACTOR SUODIVISION p <br /> OESC. <br /> OWNGH AUDRESS CITY/ZIP PHONE <br /> Susan Loney 14103 30th Avr. SF_ Mill Creek 9�012 47.5-301-SG64 <br /> TENANTNAM[ I WNTACTFORPERMIT PHONE <br /> Pam Stairs P�manorthcreckroofing.com <br /> E-MAIL <br /> "-� N�cYd: [ss L`TS'�izfp pH6AE— <br /> Clor'Ch Crrek Roofing Inc 17629 15Lh Ave SE �t105A Bothel.l. 98012 42S-4A7-79B6 <br /> cONTR.1.IciWSE a NOk'1'fICHU42L'2 <br /> USE OF DUtLDING HEnT Snl1RCE CONTRACT PRIC[OF WORK I <br /> I _l:leeldc _Gas_Olher 1— $12 , 950.00 <br /> __1— <br /> WORK O[SCRIF�TION <br /> Tcar-off 3 layers of exisCing roofing, install 1/2" CDX and new laminated <br /> rooCi.ng maCerial. <br /> PLUMBING MECHANICAL <br /> :�0. TYPE OF FIXTURE OR IT[IA NO. TVPE OF FIXTURF OR ITEM <br /> Toilcl � A/C—air hundling unils <br /> f3alhlub Forcr.d alr sysloms <br /> I.avalory(wash bosln) G�s piping <br /> Showcr Water heatcr <br /> I<ilchen sink&disposai Gas lireplace <br /> Dishvmsher Gas rango <br /> Clu�hes washar Clothos dryer <br /> Waler iiealer Range hood <br /> Sink(servicelbarlmop/ele.) Exhausl fan <br /> �ackllow prevenlcr Heal pump <br /> Uiinal Unit hca�nr <br /> Drinking founlaln �oller <br /> � Floor Jrnin Refrigerotian <br /> Ginasn Irap Woodstovo <br /> Roof drains 011ior ___ <br /> Olher <br /> CI7Y OF EVERETT LOCAL SALES TA%CCDf IS 5106 <br /> I horo6y cor�ify Ihal I huve read and examined Ihis apptication anA know Ihe s,me to be Imo and correcL All provisions of Ia�Ns antl <br /> ordinancoc�overnin�Ihis lypr,uf worY,will bn cnmplir.d wi�h whelhar speci(ed herein or not.The gronting ol a permi(dous not presume <br /> to 9ivn nulhnrity lo violile or c;mcel thA provision ol any olher s�nle Or local law ieyula�in{1 conslruclion or Uie perlormanco of <br /> cons(rucl' n.l�hal I am authviized by thu ownor of Ihis property lo pcdorm Uio work!or which applicafion is mado and I compiy wilh�he <br /> Stolc C n raclor�La v 10 27 ''CW nnd 2�J8200 WAC. <br /> Q�'I e,�a 1.�a.ci�,o �l i /�a <br /> Siynnture of OwneRConlfac�or/Aufhorized Agenl �����o <br /> ' .. _ . . ____ . . . . . <br /> . . . _ _ _ . . _.. .. .. ._. . . . ! <br />