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To: Permit Department Page 2 of 3 2015-02-20 17:40:26 (GMT) 18884000383 From: Deborah Shields <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 10732 9TH DR SE 00470300001002 F I 50 2-D Z8 <br /> LEGAL} LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> BALL, DAVID 10732 9TH DR SE Everett 98208 4252390906 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Naida Khan naida@nwpermit.com 360-945-2787 <br /> CONTRACTOR GMA Construction ADDRESS 4210 B Street NW CITY/ZIP PHONE <br /> Suite B Auburn 98001 253-736-2072 <br /> CONTR.LICENSE# G MACOI"9740Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR _Electric Gas Other $129.00 <br /> WORK DESCRIPTION <br /> Replace 1 toilet. No change in location. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> — <br /> Lavatory(wash basin) ____ Gas piping <br /> ShowerWater heater <br /> Kitchen sink&disposal Gas fireplace <br /> — <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will 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 construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Naida Khan ‘z " : -�°-- <br /> O,.�2014132.20 00:4:41 MOO' <br /> Signature of Owner/Contractor/Authorized Agent Date <br />