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May OS 11 0921a Washington Water Heaters 8663757454 p.2 <br /> l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERE7T,WA98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM :IU1170 4 PM <br /> SITE A�DHESS PMCEI_TAX LD.A PEfl�f IT iF <br /> -7" 2s" kd�2� G� � b �� ' " oa��� �/�'� ' (•�► ► D� _GIL <br /> ! lEGA LOTNO. BLOCK TRACTOFSUBDIVISIONp <br /> j OcSC. <br /> IOWNER pOORESS 7 CITYZP PHONE <br /> ��� �{�f�/1 ���Z D /-�u-'��`�-q �/..`y'/ �-t�(%tlf"�7�3�C✓ �GJ:�!J��� <br /> � TENMlTNMAE ON7ACTF RpEF"T. PHONE��j��y��� 5S/ <br /> ' I�C2CG� ��a.l�,��S �.�a�hafcva.re�'`l vu C��� <br /> I CWTi�7I���1�jTVlv �/I�Gl�-��"^�ADD ES I alN�` ls'i�l.Y ,S I 21 PMON ��},��� .L7� <br /> CONTR.UCENSE `�'-"� �� � wg,�{g <br /> u��5i-�r�� q�o oP �,e.l«vue G�a 9� <br /> USEOFBUILOING HEATSOURCE CONTRACTPRICEOFWORK <br /> 1 C iJ ��.P� I _Eleclric �_Other , �x I � �� <br /> WORK DESCRIP710N <br /> - CGi'LC-L'v'��'�, C�M.� � �� � Gt.d-�!�`V� a �,� <br /> PLUMBING MECHANICAL <br /> NO. TyPE OF fl%7URE OR REM NO. TYPE Of FlXTURE OR ITEM <br /> _ Toilel A/C-air handling units <br /> _ Dathtub . Forcedairsystems <br /> _ Lava�ory(wash basin) Gas piping <br /> _ Shower �, Waterheater <br /> _ Kilchen sink&disposal Gas fireplace <br /> _ �ishwasher Gasrangc <br /> _ Clotheswasher Clothesdryer <br /> _ bVater hea[er Rangtt hood <br /> _ SinR(service/badmop/elc.� Exhaust lan <br /> _ ¢z•rktlow preventer Heat pump <br /> W�.nal Unil hcaler <br /> Dnnking Founlain Boiler <br /> _ Floordrain RetrigaraSon <br /> Greasc irap Woodstove <br /> Root drains Other <br /> O�her — <br /> C1TY OF EVEflETT LOCAI SALES TAIC CODE!S 3105 <br /> I hereby cerility that I have read and ew�mined this appfication and know the same to be truo and correct. All provisions ot laws and <br /> ordinaces�oveminp this type of work will be compliad wiUi whether specilied herein or not.The granhng ot a permit does net presumc <br /> to give audi«ity to violate or cancel the pmvision af any r State or bcal!aw regulatir.g construclion or�he p�dormance ol <br /> cens ' .Thal I am authorized by ihe er oi ihis p e.ry to pe:torm ihe work lo��.vhich applicauan is made and I compty wilh She <br /> -State Conlr ivr Law 1� 7 R au 00 WAC. <br /> �--- .��,� � �� � ,�`-���� <br /> SignaEdre of Iwner,'Contraclor/ uthOrized Agen Date <br /> C, � <br />