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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— F.AX 425-257-8857—N�niw.everethva.urg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '�.� `��Z <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 8910 10TH DR SE 0073100000170o ZD - 0 Z2_ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC, <br /> OWNER ADDRESS dN/ZlP PHONE <br /> BARRY SMITH same as site address 98208 425-330-1155 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Cyndal/Naida 360-945-2787 <br /> CONTRACTOR \A/ESCO ADDRESS qTY21P PHONE <br /> VV 2g00 Thorndyke SEATTLE 800-398-4663 <br /> CONTR.LICENSE#`^/nSHIES9/ � OB <br /> V V/-\ <br /> USE OF BUILDING HEAT SOURCE CONTFACT PRICE OF WORK <br /> residential I _Electric �Gas_Other 2129.60 <br /> WORIt DESCRIPTION <br /> REPLACE GAS 80K BTU FURNACE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> Toile: A/C–air handling uniis <br /> Bathtub � Forcetl air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Cloihes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmopfetc.) _ Exhaustfan <br /> Backflowpreventer _ Heatpump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> other — <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correct. Atl provisions of lav.5 and <br /> ordinaces goveming this type of work v�nll be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating o�nstruction or the pertormance of <br /> construdion. That I am authorixed Uy the owner of this property to perform the work for which apptication is made and I comply with the <br /> Siate Contractors Law�827 RGW and 296200 WAC. <br /> ' 1/9/12 <br /> Signature of Owner/Contractor/Authori_ed Agent Date <br />