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SITE ADDRESS <br />331 MADISON <br />LEGAL LOT NO. <br />DESC. <br />TERESA AZONE <br />TENANTNAME <br />CONTRACTOR �nlESCO <br />v �� <br />PERMIT APPL�CATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERtTT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vwow.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 10 4 PM <br />BLOCK <br />CONTR. LICENSE it `^,AS H I ES97 � OB <br />VV <br />USE OF BUILDING <br />residential <br />WORK DESCRIPTION <br />REPLACE GAS 60K BTU FURNACE <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />28050600301900 <br />TRACT <br />/h 4"VA �� <br />� � <br />tM1T # <br />qTY21P PHONE <br />407 A& R RD OW+OV MT 59416 406-627-2494 <br />CONTACT FOR PERMIT <br />�vndal/Naida <br />ADDRESS <br />2800 Thorndyke <br />HEATSOURCE <br />_ Electric � Gas_ Other <br />PHONE <br />360-945-2787 <br />dTY21P PHONE <br />SEATTLE 800-398-4663 <br />CONTRACT PRICE OF WORK <br />950.00 <br />NO. � TYPEOFFIXTUREORITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstwe <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All prwisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The grenting of a permit does not presume <br />to give authority to vlola!e or cancel the provision of any other state or Iocal law regulating construction or the performance of <br />construdion. That I am authorized by the owner of this property to pertorm the work for which application is made and I mmply wfth the <br />State Contrectors Law 1827 RCW and 296.200 WAC. <br />T_:''-: •-; 10/4/11 <br />