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CITY OF EVERETT <br /> Application and Gas Insfallation Permit <br /> All WorkVto be Done in Actordance with <br /> Ciry Ordinance <br /> � �t . ` r� <br /> Eveiett, Washingfon.........��.....�.'.'J--•--.....'�.�....., 19�.(_.. <br /> Locat�on..il���....4!-"a^�............�....�.��.:�!.:............. <br /> ,... .C���.. . �... �.. �. <br /> Ow�fr.....�.:�:�a.�...F.lu.`.'y.:.Iir.'^.:..;._:��..:,.......r............. <br /> Applit�nt...........'. �,iYl. �a1":. �j ,'' 1 <br /> ' �. �� <br /> Y "..... ..�...... ......... .................. <br /> . � � � � I <br /> Rough'pipinq inspe[tion ____.____ i <br /> Pipe in ercess of 60' ___ -_ Gas Stoves _ _ t��� <br /> fri erators _ C��s water heaters __�!!� <br /> Gas re 9.� - ----- <br /> Gas space heaters to 70,000 B.T.U. input . _ _��-� <br /> � � � <br /> Gas space heaters over 70,000 B.T.U. irput _ _ __ <br /> (�,as fuinacCs to 400,000 B.T.U. input __ _ _ — <br /> Gas fumaces over 400��1�`B_T�V� input - <br /> Conversiu�^ u�iits to 40C.000 B.T.U. input ___ <br /> Conversion unifs over 400,000 B.T.U. input _ _ _ <br /> Small appliar�ces.-.__-_--_--------------- <br /> _ --;:;-.rmi,-----------------�------------�1�-- <br /> i.all Back!Inspection . .---�-____ Fee Paid $_�3,,,,r,�_ <br /> �I lx �_��___Aqplicant � <br /> . .:-ii <br /> � / 6 <br /> pY.. �..�,:���9{.- - - - -- -----..__ •;�- - <br /> P�ans Approved and Permit granted as requesfed iHerein. <br /> ���f��;g �---.,_ Inspector <br /> 6y <br /> PERMIT i�".' 9fii7 <br />