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si� nooRESS <br />5110S3A <br />LEGAL LOT NO. <br />JACK ALBERT <br />TENANTNAME <br />PERMI� APPLICATION <br />GITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, GVERETT, WA 9820'I <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />CONTRACTOR 1n�ESCO <br />conrR. uceNse e WAS H I ES971 OB <br />use or• eui�oiN� <br />SFR <br />WORK DESCRIPTION <br />PARCEL TAX I.O. JI <br />00500301600300 <br />TRACT � <br />5110 S 3 AVE <br />CONTACT FOR P[RMR <br />Naida Khan <br />ADDRESS <br />2800 Thorndyke <br />HEATSOURCE <br />_ Eledric � Gas _ Other <br />Replace gas to gas 40 gallon water heater <br />PLUMBING <br />NO. I TYPE OF FIXTl1RE OR ITEM <br />Bathtub <br />` Lavatory (wash basin) <br />_ Shov+cr <br />Kitchen sink 8 disposol <br />Di,hwasher <br />CIO[hC5 we5het <br />� laundry tray <br />� Sink (service/bar/mop/Mc.) <br />Dack�vw prevenler <br />Urinal <br />� Drinking Fountain <br />Floor drain <br />� Grense trap <br />� Rootdrains <br />Othrr <br />PERMIT # <br />1�9U� 05- c�. L <br />Everett 98203 360-403-0525 <br />360-945-2787 <br />CITYIZIP PHONE <br />SEATTLE 206-378-6649 <br />CONTRACT PRICE OF WORK <br />750.00 <br />N0. I TYPE OF FIxTUfiE OR ITEM <br />i�c - nir nanaung umts <br />Forceci air systems <br />Gzs pipinq <br />i Waterhealer <br />` Gas fireplece <br />_ Ges range <br />Clothes dryer <br />_ ftange hood <br />F�chaustfan <br />Heatpump <br />� Unit hcater <br />Boiler <br />Refrigeralion <br />Woodsrove <br />_ Other <br />CITY OF EV[R[TT LOCAL SALES TAX GODE IS 7105 <br />I hereDy centity that I have read and examined this appllwtion and know Ihe same to be ;rue and correct. All provisions of laws and <br />ardinaces goveming ihis type u( vnn k will be wmphetl wllh wnetner speGfea nemin or nof. i ne granUng of a p¢Ritit dces not presume <br />to give authoriry to violate or cancel the provislon af any olher state or Iopl law regulating construdion or the pedortnance of <br />wnstruction. That I am authonzed by Ihe a�mer of fhis property to pedgrtn they�ork tor which applica5on Is made antl I comply with the <br />Sla10 Contr�clory Law 1lj,27, RCW ond ^.3G.200 WAC. / / <br />' i GVL ��c-t��r,r.� 9/ / 3/ ��- <br />Sipnarure or uvm�,pntra�tof/AUlhonzetl Agvnt ' Da C � <br />