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P�RMIT 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1515 LOMBARD AVE 00553631700400 n��a�U�C(�'{ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> IOWNER ADDRESS pNIZIP PHONE <br /> SUE RAY 1515 LOMBARD AVE Everelt98201 425-350-4592 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Jennifer Burgess 206-774-9499 <br /> CONTRACTOR ADDRE55 CITY/ZIP PHONE <br /> WESCO 3909 196 St SW� LVnnwood 9d036 g00-398-4663 <br /> CONTR.LICENSEN �n�ASHIES9! � OB <br /> Vv <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Residential I �Electric �Gas_Other $14811 .00 <br /> WORK DESCRIPTION <br /> Elec to gas furnace install with 30' new gas piping, install 3 ton heat pump, install elec to <br /> gas tankless water heater, install 10' gas piping for future dryer <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> BathtuU � Forced air systems <br /> Lavatory (wash basin) s Gas piping <br /> Shower i Water heater <br /> Kitchen sink E disposal _ Gas fireplace <br /> Ciehwasher Gas range <br /> Clothes washer qothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mopletc.) _ Exhaustfan <br /> _ BackBow preventer i Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERE'R LOCAL S:.lES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know th�same to be true and correct. All pro'+isions of laws and <br /> ordinaces governing this?ype of work will be complied wi[h whether specified herein or not The granting of a permit does no[presume <br /> to give authority to violate or cancel[he provision of any other state or local law regulating wnstruction or the peAormance of <br /> construction. That I am authorized by the cwner of this property to perform the work for which application is made and I comply with the <br /> Siate Contractors Law�8.27 RCW and 296200 WAC. <br /> cyc,v4 a�nm�,y ie+�,u�,on�vn: <br /> Jennifer Bur�ess L`Nuu:errYntluyn�u=NOHIIA'dSittPA'It,cu=I�JF110tf9 <br /> Vf IA'll,rmeil-le�.ndi�Lnw1•'-+mhmm nU5 <br /> Signature of OwneUContracto Authoncad ' 8n � '� �'�"� ' ' ' Da[e <br />