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Ocl ? � 12 10:12a bl�ashington Water Healers <br />SITE <br />LOi <br />4257461563 P� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwaorg <br />APPLICATION ; ARE ACCEPTED FROM 8 AM TO 4 PM <br />� PARCEL TA7(1.0. tl <br />r'� �'�� <br />BLOCK TRACT OR SL'BDIVISION R <br />�iI�CC� .L�f'rf1-F 5`iZY�c'�(����' E���!C-�f`1��3 <br />TENAliT NA►IE tJTACf Fp/�R PEfilAfi,_ PHONE <br />I�l,l-� 4JLlA�I�IS E-MA1L� <br />W fi5N ING�TD� 1;���21'!�}� ��c�lc �� 5 � Y � <br />corrrn. ucEHse <br />,,,A�r-�,r,� vS'm �P /a€ll�vue Gva- Sva� <br />USE OF BUILOING <br />r�S[��n�i"f�A- i <br />WORK DESCR�PTION <br />� <br />� <br />I O-O <br />� <br />n <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />��loctric _ Gas _ Othcr �/(,'� <br />��,�� I �� � ��'�Z� <br />NO. I TYPE OF FlXTURE OR IiEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kifchen sink 8 disposal <br />Dishwasher <br />Clolhes washcr <br />= Waterheater <br />Sink (:+:rviceiUar/mop/e�c.) <br />6ackflow preventer <br />Urinal <br />Drinking Founlain <br />_ Floor drain <br />Grcasc dap <br />Root drains <br />_ Other_ <br />�/�(,'t.�h� � 1J� LL' vY <br />MECHANICAL <br />NO. I TYPE OF FlXTUfiE OR ITC-M <br />A/G — afr handling uniis <br />Forced air systems <br />G�s pipiny <br />T Wa;erheator <br />Gas firepWco <br />Gas ranpe <br />Clathes dryer <br />_ Range hocd <br />E�hausl lan <br />lieat pump <br />Unit healcr <br />Boiler <br />_I Rehigeratlon <br />W oodstovo <br />CITV OF EVEREIT LOCAL SI+LES iA7C CODE IS 3105 <br />I hereoy cenUiy that I have read and examinetl Ihis applicafion and knew the samc lo bo trve and correC,. All provisior� of laws and <br />ordinacoc goveming this lype ot v:ork will bv cromplied vrith whothor specilied herein or rwL'fhu grantiny of a p=rmit does nol presuma <br />Io give aullto�ity to viol�ir or cancel the prcvision ol any olher state w local law rey7ulating consW��tion or the perlortnanc;e ot <br />Consiruction. Thal I am authorized Uy the o nor ot Ihis p�pperty to petiorm lhe v.nrk tor whirh ap�lcation is made nnd I compy wi�i the <br />Stata ontractors Law 1037 RCW and :��?_00 WAC. � <br />�. � , � �� ����cLu.�� �D �Z -f2 Ft.��-���ti����.� ��, sr�,� F�,�s ��: <br />; �a�r�,/ <br />Si natUm�bi i7wnerlGontraclor/Authonzetl A ent ��ta �. L7�'�"L'�t�.,rt lx, y� <br />��c�c.,� u�- C�� ���� �>�, �C (� � �� �-,n-+��-`uc�c�� �la�!'T�����u � -!� �e�rjt <br />� � � r <br />�� <br />� <br />