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( f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / y <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � ' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - S —�— O� <br /> SITE ADDRESS Z f'ARCEL TAX I.D.N � PERMIT/ <br /> 10921 19TH AVE SE 00574700200101 j 7` _ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP P 3 NE <br /> CHEVRON PRODUCTS CO., 145 S.STA"i E COLLEGE BLVD,BREA,CA 92821 (714)671-3393 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> GLORIA HICKS(707)765-1660 EXT 706 4 <br /> CONTRACTOR TBD 5 AUORESS CIN21P PHONE <br />. CONTR.UCENSEM <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> GAS STATION WITH FOODMART _ _ _ I � � <br /> � Electric Gas Other $75,000+_ L,�1 PZ,�, <br /> �I�'I. <br /> R ACE(E) 04E N WIT K LySG G ICE SI, E,REF CA SIGNS CAN 8 <br /> GNS;M IF4 N`O�Pt ASCI , (N L E • <br /> E V DA NEW tL�iNG SI�N I N ONFIGURE(E)CABINETS INSTALL NEW MERCHANDISING EQUIPMEN 8 <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backtlow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drink;ng Fountain _ Boiler <br /> Flor,;drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and exainined this application and know the same to be true and wrrect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit dces not presume <br /> to oive authority ro violate or cancei the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.That I am authorized by the owner ot lhis property to perform the wurk for which application is made and I comply with the <br /> State Contractors Law 1 .27 RCW and 296200 WAC. <br /> Signature o O d oniractor/Authorized Agent ate � <br /> L <br />