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PERMIT APPLICATION <br /> I' CITY OF EVERETT PERMIT SERVICE:S <br /> � 3200 CEDAR STREET, EVERETT,YJA 98201 <br /> I 425-257-8810- FAX 425-257-8857-www.e�.erettwa.org <br /> APPLICATIONS ARE AC(:EPTED FROM 8 AM TO 4 PM � _�--Q <br /> SITE ADDRESS PARCEL TA%I.D,p PERMIT � � � <br /> I zs�� rz��,.kE� ����e �aze� oo6saa00000ioo io �oo r'� �1���"���� <br /> LEGA LOi NO. BLOCK TRACT OR SUBDIV:oION k <br /> cesa Section 19 Townshi 29 Ran e �5 Quarter SF Shorewe�v <br /> OWNER ADDRESS CITV2IP PHONE <br /> Uave lialvorsen, '�resident �629 R� cker Ave Eveiett, `✓V<� Uf3201 425-303-0120 <br /> TENANT NAME CONTACT FOR PERMIT Pr+oNe 206-405-0739 <br /> C i odd �t Georye E•Ma� 'o�d��;reno�nsandco r - <br /> i — <br /> � Robb�ns and Cu Foundalion Systems �1S S�iV 1a2nd Street durien WA 981f6 20G241-9101 <br /> CONTA. LICENSE# - <br /> ROBHICIi :�.;':d�JC? '�;� ;�1; <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Electric _Gas_Other 5�i���� <br /> IWORK DESCRIPTION <br /> � Replt�r� (3i existinq Gx� pu�l�� �viih san'�c ieplr�ce foundation tor each <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OFi ITEM NO. TV7E OF FIXTURE OR ITEM <br /> Toilet AiC—air handling unils <br /> Bathtu6 Fcrced air systems <br /> Lavaiory(wash basin) __ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clmhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service;barlrop'elc.) _ Exhaust fan <br /> I _— _ BackfloN preventei _ Heat pump <br /> Urinal Unii healer <br /> � ___ Dnnkin� Pounlain _ Boiler <br /> I — Floor drain � Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains _ Other <br /> Other <br /> ( — <br /> i <br /> I CITV OF EVERE7T LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify iha� I have re2d and examined this application and know itie sane to be Irue and correcL All provisions o1 laws and <br /> ordinaces goveming this type ol work will be complied with whether specified herein or not.The grenting of a permit does not presume <br /> I to give authoriry to violate o•cancel the provision of any other state or lor.al law regulating consimction or the pei{ormance of <br /> consiruction. That f am aulhorized by Ihe owner ol ihis property to p�dorm Ihe work fnr which apolicati�n is made and I comply with�he <br /> Slale CoNractors Law 18 27 RCW and 296.200 WAC. <br /> Signaiure ot OwnevConiractorlAuthorized Agent Date <br /> � <br /> 1 <br />