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FROM :Evergreen St2te Heat 8 RiQ FAX N0. �42525%660 ! Scp. 28 2010 91:09PM P1 <br /> �� C���-�av\o -' ��,.� � � <br /> PERMIT APPLICATIOW <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVErZETT,WA 98201 <br /> 425-257-A810-FAX 425•257-8857-www.everettwa.org <br /> APPUCATIONS ARE ACCEPTEC FROM B AM TO 4 PM q ���—�(J <br /> SITE AOpRESS P CEL Al(I.D./ PERMI7 k <br /> '�' �5 �6Yo . n �lj'�"�3 �()l�bp�(X�I m � `� <br /> LEGnL LOTNO. BIOCK TRACTORBUB�IVISION� <br /> DESC. <br /> �i Eci�r�y cx..huY.�l� ?,SaS �,�,�Q IAve c Ne�_q8�3 <br /> TE.NANTNAM! I NTACTFORPERMR VHONE <br /> E-MAII Q <br /> �c�J��q�y�q�. ��-V ��s.e.-1� rYLQ-� C,� � ^ '� <br /> coNra.u�vp1�A5S0`.330� !`�� �iCi �� �P✓ (/�pV�" yv�-��3�1u <br /> USE OF BUILDING HEAT 30URCE I CONTRACT PRICE OF WORK T <br /> nr <br /> �� , _Eleclric�Gas_Other a�' <br /> WORK_ DE9CRIPT�ON � �� �� <br /> � � <br /> r�}�i i <br /> LUMBING ANICAL <br /> NO�I TYPE OF FI%TUHE OR IIEM NO. TWE OF fUCT'URE OR REM <br /> 1 <br /> IToilel AIC—alr handling units <br /> , NethWb Forcod ei� syslems <br /> _' �avatory(wash basin) Gas pipinp <br /> Shower Walvr heater <br /> Kltchen sink 8 disposal Gns firrplace <br /> _ Dishwashef G06�AngC <br /> , Clothea wesher Clothes dryer <br /> Wa�er ho�or � Renge hood <br /> � Sink(soMcol4ar/mop/atc.) _ Enheuslfen <br /> � OeckAowprevemer Heatpump <br /> Urinal _ Unit hentor <br /> Drinking Founlain Boiler <br /> _ Fluordrain _ Re(tlgeretlon <br /> Groasu trap Woodstova <br /> Ra>I drelns Othar <br /> Other <br /> CITY OF EVERETT LOCAL SALE'7AX CODE IS 9105 <br /> I hareby certify that I M1Ave rAud end¢xemined lhia epplicapon antl know the eame to be Iruo and correct. All provislons of law�end <br /> ortlinancos poveming this typo of work will be compliotl wlth whethar speci5ed herein or nd.The granling of a pormd doea not presume <br /> to givo aulhoriry to vlolate or cancel ihe provision of any other elote or local law regulaUng constructi�n or the performence of <br /> cnnsiruction.Tha�I am Nuthoftzed by the oYmcr of this pmperty lo pedortn ihe v.rork for which applir.allnn la made and I compty vnth the <br /> St Co tracrors Law 18.27 RCW nnd 290.200 WAC. <br /> ��-,� v l °► ��� -i � <br /> Slgneture o vner ontrac ulbotlzetl Agent ate <br />