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�Mar 07 12 0422p Washington Water Heaters 4257461563 p.1 <br />SITE ADDRESS <br />TENANT <br />CONTR. <br />f4�i:[QI <br />P�RMIT A�PLICATION <br />CITY OF EVERETI �ERM1T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIOr15 ARE ACCEPTED FROM 8 AM TO 4 PM 3—� — I Z <br />/ PARCEL TAX I.D. # <br />�[r S� 5 1.�,� ' � �( <br />BLOCK TRACT OR SUBDIVISION C <br />A�DRESS <br />�,-, : .•..���1�.L r :.I �,..,� <br />GrT�n1 lUfl-'�E/1- <br />n <br />��ONTACT Fpy\� PERMIT� PHONE <br />lA-U.1 4.JlM L�L`S E-lAA14 <br />e uc t.��- 9�a5 <br />PERMIT # <br />Yllzo��-�II <br />iONE ��� s- 73� <br />�D�v_ ��1C <br />IO-�178� S� <br />twa,fe��y vzc �' vlim, <br />H NE itif ��y_ CON�) <br />VV� /p <br />��� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />l�� �ir�en-�'(G� � � :�. — `- _ _ <br />Electric uas _ Other �'_ � l� <br />WORK DESCRIPTION <br />L <br />; NO. <br />�-�,��- ���-eG��, L 1��:��i I"�? C(,�� <br />TYPE OF Fl7(TURE OR ITEM <br />Toilet <br />Bathtub <br />lavatory (�vash basin) <br />Showcr <br />Kitchen sink S disposal <br />Dish•.vashcr <br />Clothes washer <br />Waler heater <br />Sink (service/barlmapfetc.) <br />Backfiow preventer <br />Urinal <br />Drinkirg Founlain <br />f-loor drain <br />Grease trap <br />Roof drains <br />Other __ <br />NO. I TYPE OF FI7CTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water ��ea!er � <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil hcatur <br />Boiler <br />� Refrigeration <br />WDodstove <br />Oiher <br />CITV OF EVERETT LOCAL SILL.ES TA7C CODE IS 3105 <br />I hereby cerilily that I have read and examined this appiication and know the same to 6e:rue and correcL All pmvisions of laws and <br />ordinaces govemir.g this type ol work will be complied with whether specitied herein or not. The gren:ing of a permit dces not presume <br />to c�ive 2uthoriry to vioiale or cancel the provision of any other slate or local law regulating consWc[ion or the peAormane;e of <br />cunstruaion. ihat I 3m authorized by the owner of this property to podorm the werk for which applicalion is made and I comply with �hc <br />State Contraciors Law 1827 RCW and 296.200 WAC. j� � � <br />., � ,/� � � �� ( � ` `iLG�-'c��G'N,��1.1 G'u" �'.y. :�:: �C,y� .� ���', <br />i�--�[ .L/i•l,l /� <br />Si�nature ol Owner Cont ctodA t o ed A ent s Date `� ���U"rr �'� �� <br />v s ;` . `7i�,�;,i,�_� �"� f <br />�'�{;���% US-�- �`'r� 14� ��(ld"ll� Y �'(N1"��'L'i-CfGi� "-iGil �';"���i��l.� 'fC. �1i1�' <br />-- ."�'lG'vin K- I,,��v�,� <br />