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f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERI171T SERVICES <br /> 3200 CEDAR STREET, EVERE("T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /D—�6 O6 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1905 Lombard Ave 00437938300301 M��` � <br /> LEGAL LOTNO. BLOCN TRpCT <br /> DESC. <br /> OWNER ADURESS CIN21P PHONE <br /> Larry Johnson 1905 Lom�;ard Ave Everett98201 425-252-2100 <br /> TENANT NAME CGNTACT FOR PERMR PHONE <br /> IMelissa Croda 360-945-2787 <br /> CONTRACTOR IAfESCO ADDRESS CITY2IP PHONE <br /> 11V �1�7 2800 Thorndyke SEATTLE 206-378-6649 <br /> CONTR.IJCENSEMIA/ASHIES.7/ 1OB <br /> V1l <br /> USE OF BUILDING I — HEAT SOI�RCE CONTRACT PRICE OF WORK <br /> SFR Electric ✓ Gas_Other I 950.00 <br /> WORK DESCRIPTION <br /> Replace gas to gas 50 gallon water heater, 40,000 BTU located in Utility Room <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathlub Forcedairsystems <br /> _ Lavalory(wash basin) Gas piping <br /> 5hower i Water heater <br /> _ Kilchen sink&disposal Gas fireplaco <br /> _ Dishwashor Gasrango <br /> _ Clothes washer Clothes dryer <br /> _ Laundry lray Ranc�e hood <br /> _ Sink(sorvice/bar/mop/otc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Dnnkinc� Fountain Boilor <br /> Floor drain Refrigeration <br /> _ Greaso trap Woodslove <br /> Roof drains Oth�r <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I horeby coritity thut I have read and examinad lhis applicalion and knov�the samo to be true and correcL All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specifed her�in or not.Tho granting o(a permit does not presume <br /> lo giva authority to vioiale or cancel the provision of any othor state or Iocai law regulatir.g construction or lhe pertormance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applicalion is made and I comply with the <br /> State Contractors Law 1827 RCW and 29fi.200 WAC. <br /> i �'��� ,�.�6/6 <br /> SignaWre nf O�vnedConlractor/Authorized Agent Date � <br />