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!MY-OB-2012 0T:48 FRO�-WASHINGTON NlATER HEATERS 866375i454 T-IbS P.0�1/001 F-494 <br /> pERIVIIT APPLICATION <br /> CITY OF EVERETr PERMIT SERVICES <br /> 3200 CEDAR S7REE7, EVERETT,W�98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRQM 8 AM TO 4 Ph9 S,��— �Z <br /> SITEA�DRESS PARCELTAXI.D.ri —�PERMIT# <br /> I� l� �ICLCL'_ bU �bl �10�(X7 ��Q �I,�11�OS-��I � <br /> LEGA LOTNO. BLOCK TAACTORSUE3nIVISIONu <br /> oEsc. <br /> UWNER AP�HE55 CITY2IP PI10NE <br /> � aubLQ. �i15 �I�-� �lc�ec �u�erP.� �52Gi a�f��95`> <br /> TF1�lANTNAME FONTA(.:F RPERMR� PhONE �b�y7s`���� <br /> h'/F�� I�.1CCCCi ��t,l'U��S E�.��h��wa,��y� au � a�i .o,� <br /> �%c`�`�5+�inrGrTor! r��-��2�'�+�"° !��o eti cv s �����8 <br /> ��vue l,�Q 9�a5 <br /> CO�CENSE � oP -- <br /> I LSE OI'BUILDING , l <br /> t1EAT SOURCE CONTRACT PRICE OF WORK <br /> ��siden-I�IG�- I I ---Electr,c �as�other �� � 0��7 <br /> '---- I <br /> WORK DESCRIPTON I_ <br /> � ���lG�' � �u.�' � � G� UJGL-I�°,� � lQ CL-EPJ,� <br /> _�� MECIiA4�lICAL <br /> y- - PLYIMBING <br /> N0. TYPE OF FIX'NFE OR I'fEM NO. 7VPE OF FIX7URE DR fTEM <br /> ; __ 7oilet � . aC—airhandlir.gun45 <br /> Bathtub � Forcedairsystems <br /> Lavatory(wash basln) Gas piping <br /> , Shower ___L_ Waler heater <br /> Kitchen sink&disposal _ Gas tiroplaco <br /> � �ishwasher Gas�an�o <br /> CloLheswasher _ Clothesdryer <br /> � Water heater _ Range hood <br /> J Sink(service/badmopletc-) _ Exhaust fan <br /> BacMlow prevenier _ Heat pump <br /> Urinal _ Unit heater <br /> prinking Fountain Boiler <br /> J Floor drain � Refrige.ation <br /> Greasc trap _ Nloodstove <br /> � Raot drains _ Other <br /> � Other _ — <br /> I � CITY OF EVEflE1T LOCAL SALES TAX COUE IS 3105 <br /> II 1 hereby ceriGfy ihat I have read and examinod this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this rype of woik will G¢corr,alied with�vhether specified heroin or not.The granting oi a pnrmit docs not presume <br /> to give authoriry Io violate or cancel the pro��ision ot any other state or local Iaw regulating conslrucvon or lhe podormance of <br /> consVL ' n.That I am authorized b;�the ownor ot this pruperty to pedorm the wcrk(or which appl'icaaon is mado and I comply wilh U�e <br /> � St tc Con c;ors Ww 10. 7 RCW.and � 6.200 w C; <br /> I� �b/Z �'cv1;�2�;vta-�3 r��' �tac Ct.pr.�j ' u <br /> t 1 - Ct71t%i'12�c.r�L' i.t�� <br /> Sign ie af Owned ontracto Au horized Agent Oate �r',;�,;�.u,•L� � � , <br /> �p�i�.� u'� �� �>n�i l� � C cmt�,�c����1�,"�� ��u� -I� Co�t <br /> ������ <br /> ..�--�--- <br /> � ��� � . „� � <br /> ' d�=- � _.�� � �, ::� <br /> L . . . _ . Ja "`1:r�7. _. <br /> '. . . y .. 3,�...sl. , . . <br /> � t . . _ �"= <br />