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... ,. .��� ., .., ,. :�,� �_., . _ . .. ,.. «,... � ..,,,..,�" , ,,, . , ..,... �,_„�, _� ,.._..,.. <br /> � - -- __- - -- - � - --- - -- • <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8d10- FNC a25-257-8t357 -www.everettwa org <br /> APPUCAT!.;,'IS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.t! PERMIT# I <br /> 1211 GRAND AVE ooao9�z26o�o00 _�,�j � y pZ -�37 <br /> LEG�LI LOT NO. BLOCK TRACT <br /> �ESC T <br /> OWNER AODRESS CITYIZIP PHONE <br /> CAROLINEBLACHFORD 1211GRANDAVE [vere�;98zot �25-239-4484 <br /> TENANT NAME CON iACT FOR PERMIT PHONE <br /> _ JENNIFER COVELLO 206-774-9499 <br /> CONTRAC70R �n/ESCO ADDRESS CITYIZIP PHONE <br /> VV 3909 196t11 St SW Lynnwood 800-398-4663 <br /> CONTR. LICENSE� WASHIES971 OB <br /> USE OF BUILDING HEAT SOURCE I CONTPACT PRICE OF WORK <br /> RES ' <br /> _ Elecmc Gas_O:her I �408p I <br /> WORK DESCRIPTION � <br /> INSTALLING 33K GAS FIREPLACE INSERl <br /> PLUMBING MECHANICAL i <br /> NO. TVPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEId I, <br /> _ Tadel :JC -air hantll�nq urnls � <br /> _ BathWb Forcetl air systems <br /> _ Lavatory(wash basin) Gas pip�ng <br /> Shower 1Nater heater <br /> KdchOn S�nk 8 tli5p05�1 � Ga5 SrCplace <br /> _ D�shwasher Gas range <br /> _ Clothes��•ashcr Clothes tlryer <br /> Laundry tray Ranqc hood <br /> Smk (service�barimo��etc ) [xhaust fan <br /> ___ Backf�ow preven(er Heat pump <br /> __, Unnat Undheaier <br /> _ DrinV;�ny Fountain DoJer I <br /> _ Floor drain Refrigeralion <br /> __ Grcase trap Woodstove <br /> Roof drams Other <br /> q;hcr <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby centify that I have read and exam�ned this appl�catwn antl kno�v lhe same to be�rue antl correcl All prov�sions of laws and <br /> ord�naces govem�ng Ihis rype of work vnll be complied with whMher specd�ed herein or nol i�e grant�ng of a perm�t does not presume <br /> to grve aulhonty to vwlate o:cancel ihe prov�sien o(any oiher slate or local law regulabng�onslruchon or the performa�ce ol <br /> construcbon That I am aulhon.ed by the owner of this property to perform Ihe work lor which appl�catwn�s rnatle antl� tomply v.vlh Ihe <br /> State Contractors Law '8 27 RCW and 29G.rpp,al�(?E,�„, <br /> Jennifer Covello °°,.-�- °��°.� °;;�`°=..��•,.�� �.�° <br /> ;,:. .�,� .��, <br /> fT•�!f�^IM1�11f•!� 1ftM` <br /> Sgnatwe ot OwneuContracioriAuthonied Agent Date — — — — — — — —� <br />