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NOV-06-2009 18:12 FR041-WASHINGTON WATER HEATERS 8663TSTl5/ T-3Y1 P 002/002 F-535 <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www,everettwa.org <br /> _ APPLICATIONS qRE ACCEPTED FROM 8 AM TO 4 PM �� ` 9`D� <br /> SITE nADDRES,/$� PARCEL TAX I,D.�! <br /> I-1 �D rT�CI�V�s '�-� �F�.�.M r ` ` PEHMITY <br /> ILfGA LOT NO. BLOCK �AC.�.Op��roN �O�-(OU _ � <br /> OESC. <br /> Ol"`�r� �(J� V� ADDHESS CRYTG�. <br /> 1�i�o 1�Aac�S A� q�o �EaS-34�-�381 <br /> TENAN7NAME <br /> p� MACT F q PERMIT� ��E d�0-��9�r7,,��[-{ � 8' <br /> CON ACT p�f� �Lf�f ��nw{I�S HNAIU XJ7(.(/GL7LY 7 OLC � (u <br /> W�S�'iNCnTpn� !�ltTE2Yff�r�r�°DO /�i ekcu S � �G� �an <br /> �.����� &u.c t� i <br /> USEOFBUILDING °P /� �e`2`e �UQ 9�v°'.` ��8 <br /> HEAT$pURCE f,pllTqqCT pp�CE OF WOqK � <br /> c����� G� �lectric _Gas Other ���� I <br /> WORK DESCR1777oN ' I <br /> ��c,�.v�c� � � �CQ GF�/l.0 Gl.1Cl,l—�,r� �k �1--PiL—� � I <br /> PLUMBING _ j <br /> MECHANIGAL <br /> NO. TYPE OF FI7(TUqE OR IiEY NO. <br /> T'PE OF F7](TURE OH IiEh1 <br /> _ Toilet <br /> _, Balntub � _. A/C-airhanOlingunit5 <br /> _ Lavatory(wash D25in) w F��Cetl airsystems <br /> _ Shower _ �'+as piping <br /> _ Kitchen slnk 8 disposal � Water hetrter <br /> _ Dishwasher _ Gas firppl0ce i <br /> .,lothes washer � Gas rsnge ' <br /> � Water heater � ClOthes drye� <br /> � Sink(serviceibar/mop/etc.) -� �nge hood <br /> , Backtiow preventer -_ F�haust fan <br /> Urinal _ Heat pump <br /> � Drinking Fountain z ���t heater <br /> ` Floordrain _ Boiler <br /> a Gre:.se trap _ Rehigeration <br /> Roof qralns — `N�� <br /> � Omer � Other , <br /> — � — <br /> I — � <br /> � G7Y OF EVEqE17 LpCqL gLLES TA7C CAUE IS 31p$ <br /> j I hereby ceritify that I have read and examined mis applicafion and know the same lo be we artl coffact. All ptAylsjpru ee Iaws arW <br /> � ortlinaces goveming this type ot work will hu compG¢d with whpMer specilled heroin or not.The Orarrong ot a perm¢Ooes np�presu,ne <br /> to give authptity to violale or cancel the provision o( y other sfatc+or loral laW�e ulaG <br /> construction.That I am author¢ed by e owner of t � g �9�'^�Nuction o�Ihe peAaeman�of <br /> �StaT tractors Law'1627 R W en gg,p0�iyA P�Peny,o PeAorm the work tpr whirh applica5pn is made End 1 comply with the <br /> � � C � �. lI�-� <br /> � '9 � o OwneriContractor/ uthoriz�Agent pa�� <br />