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� i <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERE7T 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 cj --ZZ`-') 3 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1111 GRAND AVE o0a68622301000 �113C S -U 5 � <br /> LEG4L LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRE55 QTV21P PHONE <br /> JOSEPH C �41CHEALS 1111 GRAND AVE Everett 98z01 425-210-4881 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Jennifer Burgess 206-774-9499 <br /> CONTRACTOR ADDRESS CITYlZIP PHONE <br /> WESCO 3909 196 St SW� LYnnwoocl 98036 g00-398-4663 <br /> CONTR.LICENSE 7!�A IAS H I ES97� OB <br /> VV <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Residential I _Electric �Gas_Other 950 <br /> WORI( DESCRIPTION <br /> REFLACE 50 GAL GAS WATER HEATER <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> BaNtub Forced air systems <br /> Lavarory (wash basin) _ Gas piping <br /> Shower i Waterheater <br /> Kitchen sink E disposal _ Gas fireplace <br /> Dish�+asher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/baUmop/etc.) _ Exhausttan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigerat on <br /> Grease trap _ Woodstwe <br /> Roof drains Other <br /> Other <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and hnow lhe same to be lrue and correct. All prwisions of laws antl <br /> ordmaces governing this type ot work vnll be mmplied vnth whether speciLetl herein or not.The granting of a permit does not presume <br /> to give authority to viola[e or cancel the provision of any other state or local law regWating wnstruction or the pertormance ot <br /> constructlon. That I am authorized by the o�mer of this property to pertorm Ihe work for which application is made and I compiy wM1h the <br /> SWte Con[ractors Law 1827 RCW anU 296200 WAG. <br /> c rn,�ceq aqnm w,mimn xu�an� <br /> Jennifer Bur ��7� ',"�� �����n8man�[•IICAi11kM15(IIFNIi,cu•IqHi16•.L51 <br /> 19 NlII,cmn�b�mrllnpox�inmLL<om nUs <br /> Sgnatureof OwnerlContrecto Authoncatl � n '""' ���- ' "' Date <br />