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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.Drg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />5012 27TH AVE W 29043400403300 <br />LEGAL LOT NO. BLOCK I TRACT <br />DESC. <br />OWNER ADDRESS QTY21P PHONE <br />GERALD WELLY same as site address ever 98203 425 348-9433 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Naida Khan/Cyndal Millhollin 360-945-27$7 <br />0, <br />CONTRACTOR WESCO ADDRESS CITYrZIP PHONE <br />2800 Thorndyke SEATTLE 800-398-4663 <br />CONTR. LICENSE it WAS H I ES971 OB <br />USE OF BUILDING HEAT SUuRCE I CONTRACT PRICE OF WORK <br />RESIDENTIAL _Electric /—Gas_Other $1300 <br />WORK DESCRIPTION <br />REPLACE GAS 50 GALLON DIRECT VENT HOT 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 />Bathtub Forced air systems <br />_ Lavatory (wash basin) Gas piping <br />_ Shower i Water heater <br />_ Kitchen sink 8 disposal _ Gas fireplace <br />_ Dishwasher Gas range <br />_ Clothes washer Clothes dryer <br />_ Laundry tray Range hood <br />_ Sink(seivice/bar/mop/etc.) _ Exhaust fan <br />_ Backflow, preventer _ Heat pump <br />_ Urinal _ Unit heater <br />_ Drinking Fountain _ Boiler - <br />_ Floor drain _ Refrigeration <br />_ Grease trap _ Woodstwe <br />_ Roof drains _ Other <br />Other <br />CITY OF EVERETT LOCAL SALES TA.v CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein 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 construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the wort, for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />