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Dec 17 11 01:24p Washington 1'/ater Heatere 4257461563 p•� <br />SITE <br />TENA!(T <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9J201 <br />425-257-8810 — FAX a25-257-SB5� — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AAA TO 4 PM <br />.�� � <br />� �`I�"C�l(�l G� }-i V <br />LOTNO. BLOCK <br />k�/rTE2 <br />PARCEL TAX I.O. # <br />?�IUl��ci��c:�Z � <br />iRACT OR SUBUIVISION i <br />T�/ PHONE <br />�i(.� o_ueu � <br />vu� l.va. 9Sva5 <br />� <br />C� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE F WORK <br />r� sz d P,r�-�(�. ( � Eleciric _ Gas _ Other �f l� <br />WORK DESCRIPTION <br />C <br />Q�� � ���Cw (��a:�12°.� %U2 a-� <br />NO. � 7YPE OF FfXTUAE OR REM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen siNt 8 disposal <br />Dishwasher <br />Cfoth¢s washer <br />Waten c�alcr <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />DriM�ing Fountain <br />Floor drain <br />Greasc trap <br />Roof drains <br />Other <br />� <br />TYPE OF FIX7URE OR ITEM <br />A/C—airhandling units <br />Forced air systems <br />Gas piping <br />Waterheater � <br />Gas lireplace <br />Gas ranpe <br />Clothes dryer <br />Range hood <br />Ezhaus[fan <br />Heal pump <br />Unhheater <br />Boller <br />Refrigc2lian <br />Woodslove <br />Other <br />dTV OF EVERETT LOCAL SALESTAX CODE IS 3105 <br />I hereby ceri0fy ihat 1 have rend and examfned ihis applicalion and know iho same to be trua aad correct All prm�sions of laws and <br />ordinaces goveming this lype of work will be compGed with whelher spacilied herein or not. Tho 9rant'rng of n permit does not presume <br />to give aulhority to vioiato or cancel the provisfon of any olhar stat or locat law regulating construction or tho porfortnanca at <br />crons tion. That I am aulhorized hy the owner t this propery t �trnm the Nvrk lor which applieation is mede and 1 comply with the <br />Stale Co tractcrs Law tY.27 RCW and 296.20 AC. � <br />�, n A i /' � l/ II n. ... �/ i�1�10/1/ <br />Owner�con�raaoqnuuionzea agent un�c � � ' � <br />l.l�-e- � 1V1,� ��(l� � ��Y C�l�Tlti'C�C�'U� �`-iCcl� �Qf'YVU.� <br />