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/_ �.. <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 g—U `�''J <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT N <br /> 1011 EDWARDS AVE 00451500800402 ll `�o <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS QTY21P PIiONE <br /> MARSHALL DORMAN SAME AS SITE ADDRESSS everett se2o� 425-252-6760 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ICyndal/Naida 360-945-2787 <br /> CONTRACTOR 1A/ESCO ADDRESS f]7Y21P PNONE <br /> V V 2800 Thorndyke SEATTLE 800-398-4663 <br /> coNrre.ucer+sea WASHIES971 OB <br /> USE OF BUILDING HEAT SOURCE CONTRACT PR�CE OF WORK <br /> I I <br /> residential I _Electric �_Gas_Other 9�(�,QQ <br /> . <br /> WORK DESCRIPTION <br /> REPLACE GAS 50 GALLON HOT WATER HEATER <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet fUC—alr handling units <br /> Bathtub Forced air systems <br /> Lavatory(�.vdsh basin) _ Gas piping <br /> Shower i Water heater <br /> Kitchen sink&disposal _ Gas lireplace <br /> Dishwasher Gas range <br /> Cbthes washer Cblhes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ F,chaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Untt heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeretion <br /> Grease trap _ Woodstwe <br /> Roof drains Other <br /> Other <br /> q7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certtity that I have read and examined this appiication and knowthe same to be true and correct. All prwisions of laws and <br /> ordinaces governing thistype of�.wtk will be mmplied with whether specified hereln 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 oonstruction or the pertormance of <br /> construction. That I am authori:ed by the owner of this property to perform the work for which application is made and I mmply with lhe <br /> Siate Contrectors Law 18.27 RCW and 296.200 WAC. <br /> T<<�-:.-_ . 8/3/11 <br /> Slgnature o Owner ContractodAuthorizetl Agent ate <br />