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To: E Page 6 of 8 2016-01-19 21:59:52 (GMT) '18884000383 From: Deborah Shields <br />51TE ADDRESS <br />6012 MANOR PL <br />LEGAL LOT NO. <br />DESC.� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982�1 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />0041 31 00001 2CJ4 <br />BLOCK � TRACT <br />OWNER ADDRE3S <br />CLYDE A MINER 6012 MANOR PL <br />TENANT NAME CONTACT FOR PERMIT <br />Naida Khan <br />CONTRACTOR ��5��in.ton Ener AD�RESS <br />� �y s��S co, �_�_c 3909 196th St StN <br />CONTR. LICENSE # W 1� S t l l E�U� ��� <br />!'4 <br />usE oF Bui�oir�� <br />�F� <br />WORK DESCRIPTION <br />REPLACE GAS WATER HEATER <br />PLUMBING <br />NO. 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 />Urinal <br />Drinking FQuntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />Electric � Gas _ Other <br />CITY/ZIP <br />Everett 9H2O3 <br />CITY/ZIP <br />Lynnwood <br />PHONE <br />425-347-3752 <br />PHdNE <br />��0-�4�-���� <br />PHONE <br />80Q-398-4663 <br />CONTRACT PRICE OF WQRK <br />• ! it <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />1 <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 />' Exhaust fan <br />I He�t pump <br />Unit heater <br />' Boiler <br />Refrigeratian <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 15 31d5 <br />I hereby ceritify that I have read and examined this application and know the same to be irue and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The grantiny of a permit does not presume <br />to give authority to violate or cancel the provision of �ny other state or local law regulating construction or the perform�nce of <br />construction. That I am authorized by the owner of this propeRy to perform the work for which application is made and I comply with the <br />State Cont��� ' J� q''? ��','V and 296.�/���(�!p; i(�, y <br />. . �`fHc '�i�Y_c t J�ixuf-��nvr�ln <br />��,-w f tr � �,�� �� t�y , �fv cr J_i rr(- o�clio o��1, <br />r� w Y�'"�%`- t ,�i. tzi�i 1,t�{ Pmail i.r:�n ra�._ nui�Fi nr rr>m, c-US <br />Signature �r�� ,��,� ,�,,,, ,,,athorized A � t " �` ' ��� � ' ' Date �� %� <br />✓ <br />1 <br />