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- � - -- � <br /> PERMIT APPLICATION I, <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 — wv✓w.everettwa.oig <br /> APPLICA?IONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # P RrI # <br /> 2209 LOMBARD AVE 00439147500500 � I 1 I _ �J I <br /> LEGAL LOTNO. BLOCK TRACT <br /> CESC <br /> OWNER ADDRE55 dT//ZIP PHONE <br /> LINDA WELLY 2209 LOMBAP.D AVE Everett98023 425-343-5802 <br /> TENANT NAG1E CONTACT FOR PERMIT PHONE <br /> Jennifer Covello 206-774-9499 � <br /> CONTRACTOR ADDRE55 QTV21P PHONE ' <br /> WESCO 3909 196 St SW, 800-398-4663 �' <br /> Lynnwootl 98030 <br /> CONTR. L�CcNSE�� �n/ASHIES97 I OU <br /> VV <br /> USE OF BU{LDING HEAT SOURCE CONTRACT PRICE OF WORK II <br /> COfT1f1l8fCla� _eiectnc �Gas_otner 950 �i <br /> \NORN DESCRIPTION <br /> REPLACE 50 GAL WATER HEATER <br /> PLUMBING MEGHANICAL <br /> NO. TVPE OF FIXTURE OR ITEtn NO. � NPE OF FIXTURE :.`R ITEL7 <br /> To�iet A/C -ah handlmg um�s <br /> Ba[htub Fcrced ar systems <br /> Lavatory (wash basin) Gas pipirg <br /> Showar � Water heater <br /> Kitchen sink& d�sposal Gas fireplace <br /> Dishwasher Gas range <br /> Ctothes wasner Clothes dryer <br /> Wundry Uay Range hootl <br /> _ Sink (service/baUmop/etc) Exhaust fan <br /> Bachflow preventer Heat pump �. <br /> Urinal Und hcater <br /> _ Drinking Fountain Bo�ler <br /> Floor drain Refngeration <br /> Grease trap Wootlstove <br /> Root drains Other <br /> Other <br /> � <br /> CITY OF EVERE77 LOCAL SAlES TAX GODE IS 3105 <br /> I hereby cerlhfy that I have read and examined this applicaLon and know the same to be true and correct All pwvisions of lavds and <br /> ortlmaces governing this type of work vnll be complied wdh whether spenfietl herein or not The grantmg of a permrt does not presume <br /> to grve authon�y to violate or cancel the provision of any other s�ate or local law regulating construction or the pedormance of <br /> construction That I am authoncetl by the owner of this property to perform the worM,for whlch application is made and I comply with the <br /> State Convactois Law 1A 27 RCW antl 296 200 WAC <br /> Oigha!ry Lqnm b�lm�iier BwSnt <br /> Jennifer Bu_ r�ess CN��Wn¢h�puv�ef+a=�qHllf.:E$tRFF'li,cu=NOPIII1tiC5� <br /> GEfNII,��myi��<��r�ln�}nr:pumh[aT 4U5 <br /> Signature of OwnerContracto AuthonZatl7i 2h �" '" ""' " Date <br />