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SITE ADDRESS <br />5308 S 4TH AVE <br />LECJ+L LOT NO. <br />DESC <br />TERRY SMITH <br />TENANTNAME <br />CONTRACTOR �A/ESCO <br />vv <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wvwo.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />CONTR. LICEtJSEd WASHIES97 I OB <br />USE OF BUILDING <br />residential <br />WORt< DESCRIPTION <br />PARCEL TAX I.D. # <br />00500600006700 <br />TRACT <br />same as sile address <br />CONTACT FOR PERMIT <br />Cvndal/Naida <br />ADDRESS <br />2800 Thorndyke <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />REPLACE GAS 50 GALLON H07 WATER IiEATER <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Showef <br />Kflchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sinh (semcelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinhing Fountaln <br />Floor drain <br />Grease trap <br />Roo1 tlreins <br />Other <br />PERMIT # <br />1'�'11?�2 - �h <br />pN21P PHONE <br />98203 425-327-9377 <br />PHONE <br />360-945-2787 <br />dTY21P PHONE <br />SEATTLE 800-398-4663 <br />CONTRACT PRICE OF WORK <br />950.00 <br />NO. I NPEOFFIXTUREORITEM <br />A/C — air hantlling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firep�ace <br />Gas range <br />Clothes dryer <br />Range hc+od <br />Exhaustfan <br />Heat pump <br />Und heater <br />6otler <br />Refrigeration <br />Woodstwe <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this appliwtion and hnow the same to be true and correcL All provisions of laws and <br />ordinaces governing thistype of work �+nll be complied ��Ih whether specdied herein or not The granting of a permit tloes not presume <br />to give authority to violate or cancel the provlsion of any other state or bcal law regulating mnstruction or lhe pertormance of <br />construction. That I am authorized by the owner of this property le perlorm the wnrk for wh�ch application Is made and I comply wtth the <br />State Contractors Law 18.27 RCVV antl ^<96200 WAC. <br />- 1/31/12 <br />Signature of Cwner/Contractor/Auihoncetl Agent Date <br />