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i � <br /> � PERMIT APPLICATION � <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRFET, [VEP,ETT, WA 03201 <br /> � 425-257-8810—FAX 425-257-B857—tvww.evere�hva.org <br /> I <br /> APPLICATIONS ARE ACGEPTED FROM 8 AM TO 4 PM <br /> I SITE AD�RESS PARCEL TAX I.D.# 5 _ �7 �D9 <br /> � PE IT# <br /> 11323 7_ND AVE SE 00573600000�00 jc_ � <br /> I LEGA LOT N0. ULOCK I TRqCT <br /> I DE:iC <br /> OWNER ADCIRESS CINl7.IP PHONE <br /> � TIMOTHY BORGFORD 11323 2ND AVE SE e�e�Cu sezoa q25-231-3321 <br /> I TENAN7 NAME CONTACT FOR PERMIT pHONE <br /> � INaida Khan 3G0-945-2787 <br /> I CON71iACTOR 1A/ESCO a��ORESS CI7YlZlp pHONC <br /> vV <br /> � coNtrcuceNsea WASHIES97106 280� Thorndyke SEAT7LE 800-398-4463 <br /> I USE OF BUIL�ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR ���ec,dc �Gas,ome^ � �s�,� <br /> WORK DGSCRIPTION <br /> � REPLACE 50 GALLON GAS WATER HEATER <br /> � <br /> � PWMBING MECHANICAL <br /> I N�• TYPE OF FIX7URE OR IiGM ' <br /> NO, TypE OF FIXTUR[OR IT[M <br /> Toiiet {VC-air handling uni,5 <br /> i t3athfub — <br /> I _ Lavatory(wash basin) _ Forced air systems I <br /> Ga5 pipin9 i <br /> � _ Shower t Watef hratet i <br /> � _ Kitchen sink&disposal ` Gas freplaca <br /> I _ Dishwa;hei Gas range <br /> � Cln!hASwayher CIO;heStlryCf <br /> ` Laundry tray Range hood <br /> Sink(servio^,badmopfetc.) Exhaust tan <br /> � � 8ackllow pn:venter Heot pu�np <br /> _ Urinal Unit heatcr <br /> , _ Drinking Fountain I3oiler <br /> �� _ FloOfdrain i Hefngero;�on <br /> I� _ Grease trap Woodstove <br /> _ Rool drains Othcr <br /> i _ OUier _- ----. <br /> I ' <br /> ICIT'O��VER[77 LOCA�SAlES TAX CODE IS J706 <br /> I I��ereby ceritify that I have read and ezaminod�hi6 appli�a}ion a�d knOw Ihe same tn be irue and comect. All provisions of laws and <br /> ciLlin3CCs goveming ihis ty0e ai Wofk lvill be CnmplirA w@h whc;har 6pecificd hcrcin or not The grentluy uf a pefmlt doe5 nal presume <br /> to give authonry to:iolate or cancel the provlsion of ony other state or local Iaw regulating�enstruction or the pe�ortnance of <br /> ronsiruc,lon Tbat I 3m aulhorized by the o�mer of ihis propeny to perfor*n the�rork for which apGlication is made and I compiy vnth the <br /> I S!aIC COntfOc'ors L;iW 7 . CW and;,9G200 WAC. <br /> /�U l%� s <br /> I S�ynature o .merJ' oM actot/ utnon:etl c�en�f---� <br /> �—,_- ..-�-.-------- <br />