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_ � <br /> — � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—ww�nr.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4 �aS �II <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 10121 EVERGREEN WAY #3 28042400200100 /l 8 ' D <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS Q7Y21P PHONE <br /> UYEN NGUYEN SAME AS SITE ADDRESSS Everen 9a2oa 425-348-6941 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S' ✓�z,_S �u. ,(�u.� INaida Khan 360-945-2787 <br /> CONTRACTOR �A/ESCO ADDRESS Q7iG.IP PHONE <br /> 1�� 2800 Thorndyke SEATTLE 800-398-46G3 <br /> CONTR.LICENSE1f�n/ASHIES97 1 OB <br /> vv <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> COMMERCIAL I _Eiectric �Gas_Other $950 <br /> WORK DESCRIPTION <br /> REPLACE GAS WATER HEATER. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUREOR ITEM <br /> Toi�et _ A/C—airhandling units <br /> Bathtub _ Forced air sys[ems <br /> Lavatory(vrash basin) _ Gas plping <br /> Shower i Water heater <br /> Kttchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mopletc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greasetrap _ Woodstwe <br /> Roof drains Other <br /> Other <br /> qTY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tha!i have read and examined this application and knowthe same to be true and correct. All prwisions of laws and <br /> ordinaces governing thistype of work will be mmplied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or tocal law regulating constructlon or the performance of <br /> construction. That I am authorized by the owner ot this property to pertorm the work for whkh application Is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> 4/22/11 <br /> Slgnature of'Owner/ContractorlAuthorizetl Agent Date <br />