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� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. Wi+ 98207 <br />�25-257_g810 - FAX �25-257-fi85i - :,�vvd everettv.a org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS �� PARCFL TAX I.D. tt PERIAIT d <br />4928WILLMlNGTONAVE _� o0a�o2uo0o6a0o _ _ _ l IYi��iU -Q(��p_ <br />L65%�. LOT NO. I BLOCN TRACT <br />r�r-sc � � <br />OWNER A�DRE55 CITY2IP PHONE — i <br />STEVEN V/�N ANTWERP 4928 WILLMINGTON AVF Evere�� 9A203 425-343-5500 <br />, TENANT NAME CONTACT FOR PERfd1T PHONE � <br />'JENNIFER COVELLO 206-774-9499 <br />CONTRACTOR �A/ESCO A�DRE55 CITYlLIP PHOHE <br />�� 3909 196th St SW Lynnwood 800-398-4663 <br />CONTp. UCENSEa WASHIES971 OB � <br />USE OF BUILDING HEAT SOURCE � CONTRACT PR�CE OP WORK I <br />RESIDENTIAL �e�ecmc __ cas_o;ne� <br />WORK DESCRIPTION <br />FURNACE AND f iEAI PUh4P REPLACEMEN i <br />TVPE OF FI%TURE OR ITEM <br />� Tcdet <br />DatM�U <br />Lavatory (wash basm) <br />Show2r <br />Kdchen sink 8 disposal <br />Di :hwa;her <br />I Cbthes �wshet <br />__�Laundry tray <br />Sink (;erviceibarhnop'ek 1 <br />HacAflow Grevenler <br />lhmal <br />__ Drinking founlam <br />Flovr drain <br />Greasetrap <br />�I Rocf dra�ns - --- <br />Othrr <br />NO. <br />:: : <br />TYPE OF FI%TURE OR RBd <br />�—___ __.— .—_ __ . ___ _._ _. <br />. A'C - a�� ha�id�in; um�!s <br />i � Fo!cetl aa Syslems <br />Gas pipmg <br />Water heater <br />Gas 5replace <br />Gasrange <br />-� clothes a��c� <br />_ Ran�e hocd <br />Erhausll,m <br />,— I1eat P.�mp <br />Und hea;e' <br />Boder <br />Relrige�.�t�un <br />_ Wood;�ove <br />Other <br />_I . . - ------ <br />� - — - -- -- - — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cenlity that I have read ar.d eaaminetl Ihis application antl F.�ow the same to be hue and conect All nrovisions of laws and <br />ora�naces governmg Ihis type of work vnll be comp6ed w�dh whethcr speuhetl herein or not The grent�ng of a permit dces not presume <br />�o give au;horAy to violate or cancel ihe prcwsion of any clher slate or lowl law regulahng constructwn or the perlormance of <br />con,vi.chen That I am authonzed by Ihe owner of ihi; pwperty to perform the work for whiUi apphcabon is made and I compty wrth Ihe <br />State Ccntracto , Law 18 27 RCW and 29�ii4QQ���,,� <br />Jennifer , ,,. .-o.._ ��.�u�, ..,,,.,.�, <br />Cove l l o "° h.� - �°,.��- <br />,,� .�..��..�.,.� <br />I __ _ . n...�� v.ffL{Il�>>Af.•M <br />S�ynaturc o( O�.vner�Contradcr��Whorzed Agent Uate <br />, _. . _. ---- � - I <br />