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( f <br /> � PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES � ; ri <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �A�� <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S�oB—> <br /> SITE ADDRESS Z PARCEL TAX I.D.# � PERMIT# � <br /> 10921 19TH AVE SE 00574700200101 � ' /,�� — �`� <br /> L ' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP P NE <br /> CHEVRON PRODUCTS CO., 145 S.STATE COLLEGE BLVD,BREA,CA 92821 (714)671-3393 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> GLORIA HICKS(707)765•1660 EXT 706 4 <br /> CONTRACTOR TBp 5 ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRIC OF WORK <br /> GAS STATION WITH FOODMART � $� + <br /> Electric Gas Other �'G� <br /> REFACE(E)POLE SIGN WITH NEW HALLMARK LOGO&GAS PRICE SIGNAGE,REFACE(E)CANOPY SIGNS WITH(N)CANOPY 8 <br /> S�GNS,MODIFY CANOPY FASCIA,INSTALL(N)LOW LEVEL LED LIGHT BANDS AT CANOPY FASCIA, REPLACE(E)SPANNERS, <br /> REDECAL DISPENSERS, PAINT BUILDIN T�` <br /> PROVIDE NEW 6UILDING SIGN. <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Oishwasher Gasrange <br /> Ci,thes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drein Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces 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 per�orm the work for which application is made and I comply with the <br /> State Contractors Law 1 27 RCW and 296200 WAC. <br /> Signature o 0 d ontracrodAuthorized Agent ate <br /> ��I <br />