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PERMIT APPLICATION 53� 2 <br /> CITY OF EVERETT PERMIT SERVICES ��l <br /> 3200 CEDAR STRE[T, EVERETT, INA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everethva.org <br /> APPUCATIONS ARE ACCEPTF-0 FROM 8 AM TO 4 PM a �I ({ �p 7 <br /> SITE ADDRESS PARCEL TA%I.D.# PERMIT N <br /> � _ 1621 C;OIb AV0 00438034001100 tii���2-� Z`1 <br /> LEGA LOTNO. BLOCN TRACT <br /> oesc._LOTS t 1 & �2 BLK 340 D•00 EVEREIT DIV L PLAT OF <br /> OWNEA ADDRE55 CITY2IP PMONE <br /> Larry Binder 1621 Colby Ave e�e�en sazo� 425-252-2028 <br /> TENANT NAME CONTACT FON PERMIT PHONE <br /> Melissa Croda 360-945-2787 <br /> CONiRACTOR IA/ESCO ADDRESS CITYlZIP PHONE ' <br /> �� 2��0 Thorndyke SEATTLE 206-378-6649 � <br /> CONTR.LICENSEN WASHIES97�)OB <br /> USE OF BUILDING HEAT LSOURCE CONTRACT PRICE OF WORK <br /> SFR __e�a«�� ✓ Gas_Other 4578.00 <br /> WORK DESCRIP710N <br /> Replace 60 BTU Gas to Gas Furnace Model #! 352AAv36060 <br /> PLUMBING MECHANICAI <br /> NO. T1'PE OF FIXTURE OR REM NO. TYPE OF FIKTURE OR ITEM <br /> Toilet FVC—alr handling units <br /> 6alhtub i Forcedairsyslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kltchen sink&disposal Gas Greplace <br /> Dishwasher Gas range <br /> Clothos washer Clothes Aryer <br /> Laundry iray Ranga hood <br /> Sink(servico/bedmop/elc.) Exhausl fan <br /> BackOow preventer Heal pump <br /> Urinal Unit heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Greasetrap Woods!ove <br /> Ronf drains Olhcr <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I heroby cerilify that I havo read and ezemined this application and know the samo to be true and corred. All provisions ot laws and <br /> ordinaces goveming this type of work will ba complied with whelher spocified horeln or not.Tho granting of a pormit does not presume <br /> to give euthorlty to vlolate or wncel the provisfon of any other stale or local law regulating construction or the perlormance of <br /> construction.That I am authorized by the owner ot fhis property to pedorm N�e work tor which appiication is made and I comply with the <br /> State Contrectors Law 1R.27 RCW�nd 296200 WAC. <br /> �/.d!O/'�(t� 07�/�/� <br /> Signature o OwnedControctor ulhonzed Agent a�te <br /> I <br />