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FROM :Evergreen State Heat & Rif FRX N0. :4252596660 � Nov. 01 2010 98:SBRM P1 <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 90201 <br /> 425-257-8810-FAX 425-257-8857-www.evereiiwa.org <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� ,..� ../j/ <br /> BITE ADP SS PARCEL TAX I.D.M I p,��j IT� � <br /> ag��a `���� 'Rve��A Yd o; � vo <br /> LEGA LOTNO. BLOCK TRAGTOR9UBOIVIEIONM <br /> �ESC. <br /> OWNER AD S ITY21P PM NE <br /> ('.�-�.� �_. P,� g�a Qu���2 Y�v� ��,ov�tl, y�-a�_sc�rh <br /> ('TEN�ANTN CONT�C7FORPERMIT ya�.a� 3,��. <br /> , �U �'�I'1►�(:..�1. V� I �p.rp�.� e•Mu� <br /> �� ��T � 1�t2-F�l� `���O�Ci L �'1TFTfiP—'R <br /> �-u�, �!�tv �; �Q y a5 �a�a au� <br /> CONTR.LICENSEM �•,���1 ,`� <br /> eve ►-a so�a G► w �» <br /> USE OF ILDING HEAT SOURCE CONTRACT PRICF OF WORK <br /> C1 (� C (� <br /> A ktiQ n �4�. Y _Electnc Gas_,Olher ����•-- <br /> WORK DE9CRIPTION <br /> �s��.v C_�.o� �� <br /> PL ING EC ANICAL <br /> NO. TYPE OF FD(TURE OR REM NO. TYPE OF FIXTLRE OR ITEM <br /> Toile� A/C-air hendling units <br /> Bathtub � Forced Air systems <br /> Lavetory(wash basln) Gas piping <br /> Showor Weler haaler <br /> Kllchen sink 8 disposal _ Gas fireplace <br /> pishwnshur Gas range <br /> Clothes wnshor Cblhes tlryer <br /> Wnter hoTter Range hood <br /> Sink(sorvicelbarlmop/etcJ E#�aus�fan <br /> Backflow preventor Heal pump <br /> � Urinal Unit hoa�pr <br /> D�nking Fountain Dollx <br /> Floor drein RefrBe�atlon <br /> Greese trap ,� Woodstove <br /> Roof tlfeins Other ___. <br /> Other _ , <br /> CITY OF EVERETT LOCAL SALiS 7AX CODi IS 3103 <br /> I horoby certify Ihnt 1 have reaA antl exeminr.d thls eppilcetlon end know the same to be true end correct. All pravlsions of laws and <br /> ordinanc�s govominp this type of worh Htlll be comD�iod with whether spedfieA herein or not.The grantinp of e pettnit dces not presume <br /> to glve aulho�ity�o vioiato or cuncel Iho provision of any nthor stale or local law rxgulaling construcliGn w the peAormance of <br /> consiruclion.That I am authorizecl by lhe ownet of ihla pmpnrty In paAorrn Ihn wnrk fnr Hfilah npplir.q6on is mede nnd 1 comO�Y�lh the <br /> S te Contraclors Law 7827 RCW end 296.200 WAC. <br /> C 1� 1 ' \ _ 1 <br /> SlgnaWreof v.ner ntra r ulhoAzedAgenl Date <br /> L�.—. . .-- _.- . - <br />