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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRCCT, EVERE7T, WA 96201 <br /> 425-257-$810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEp FROM 8 AM TO 4 PM a— oL3 —�� <br /> SITE ADDRESS PARCEL TAX I.D.il PERMIT# <br /> 10121 EVERGEEN WAY#3 2so4zaoozooloo yV�c�q 0 a-p3� <br /> LEGAL LOTNO, BLOCK TRACT <br /> o[ac. <br /> OWNER AOURE55 CITl21P PHONE <br /> UYEN NGUYEN 10121 EVERGEEN WAY#3 eveaerr,sezoo 425-776-8300 <br /> TENANTNAME CONTACTFORPCRMIT 7HONC- <br /> Naida Khan 3G0-945-2787 <br /> CONTRACTOR �A)CSCO AADRE55 qTY21P PHONE <br /> ���' f1 .I 2800 Thorndyke SCATfLE 206-378-6649 <br /> CON7R.LICENSEx WASHI�S.77 I OB <br /> U3E OF BUILDIYiG HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR ,Etec(ric �Gas_Other ( g50.00 <br /> WORK DESCRIPTION <br /> REPLACING A GAS TO GAS 50 GALLON WATFR HEATER <br /> PLUMBING , HANICAL <br /> � NO. iYPE OF FIXTURE OR ITEM N0. TYPE OF FIxTURE OR ITEM <br /> Toilet A/C—airhandling unita <br /> � Bathtub Forced air systams <br /> Lavatory(wash basin) _ Gas pipinp <br /> Shower i Water heater <br /> 4 I<itchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clotnes wasner Clolhes dryer <br /> � Laundry tray Renge hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> ' 8achflov�pieventcr Heai pump <br /> Urinal LJnit healer <br /> � Drinking Fountain Boiler <br /> Fioor drain Rafngeration <br /> Grease trap Woodstove <br />� = Roofdrains = OthEr <br /> Qthrr <br /> pTY OF EVEftEIT LOCAL SALES TNC CODE iS 1105 <br /> �I hereby wrtiry that 1 have read and examined this applicatios and know the same to be true and corred. All pruvisions of laws and <br /> ordinacea governing this type of work will be wmplled wilh vrhelhei spe�ifed herei���r not.The grentlng of a permlt tloes not presum? <br /> to give authority to violate or cancel the proviaion of any other state,.r Ioai law regulating conslrudion or the performence of <br /> construdion, That!am euthorized by the owner of this property ta perTorm the work for which application is made and I comply vnth the <br /> Stata Contractoro La.v�8,'.7 RCW ond 206200 WAG � <br /> (�Y��b�� 2�Z3�(T� <br /> i�natum of CN+na � nntr?ct�r/Authonzetl�pent - Dat <br />