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AUG-31-2012 12:21 FRO�-VIASHINGTON wATER HEAiERS <br />SITE <br />86fi3757454 T-811 P.001/001 F-187 <br />PERMIt APPLI�ATION <br />C11`Y OF EVER�TT PERMIT SERVIGES <br />3200 C[DAR SIREET, EVEREl"f, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetiwa.org <br />APPLICA710NS ARE ACCEp7ED FROM B AM TO 4 pM <br />� /� �� PARCELTAXI.D.N <br />� �"� GD 57U y3 �l Dl �(o 0 <br />LOTNO. BLOCK TAACTORSIJBDIVI510N/f <br />`��Cil�,2 <br />�ranNr ��auic <br />CW�V �� <br />corma. ucu+: <br />�1l�� �n.�%�"TE2 <br />U <br />USE OF CUILOING <br />r�sz��e�-�«. f <br />WORK DESCRIPTION <br />C <br />N0. <br />`1,%US l(�'�=" <br />TYPE OF F�.KTl1qE OF 17LM <br />Toilet <br />� Battitub <br />Lnvatory (wash hasin) <br />� Shower <br />Kitchen sink & disposal <br />^ Dishwasher <br />' Clolheswasher <br />� Walerhpalef <br />Slnk (service/badmop/etc-) <br />� BacMlow preventer <br />Urinal <br />� �rinkinp Fountain <br />Floo� drain <br />Grease l�ap <br />Roaf drains <br />Olher <br />:T F H PEFiMfT` <br />' �GU2l ��5 <br />HEATSOURCE <br />_ElecUic �as_Olher <br />� <br />NO. <br />PHONE <br />C�a. 9�a5 <br />� 3-I��Z � <br />PERMRb <br />� <br />i <br />ioHe ZO(oJ !� <br />� os S^ii 2, <br />CONTRACT PRICE OF W <br />:� �� � <br />����� ��� <br />7YPE OF FIXTl1R[ OR �TkT1 <br />A/C — air handling unrts <br />Forced air systoms <br />Gas piping <br />WatBr healer <br />Gas fii�place <br />Gas rango <br />Cfolhes dryer <br />Range hood <br />F�chaust tan <br />Heatpump <br />Unit naator <br />eo��er <br />RefrigoraUon <br />Woodstove <br />C�I'Y OF EVERER' LOCRI. SALFS TAX CADE IS 31p5 <br />i hereby Cerdify that I have read and examined this applicaGon and know lhe sarne tn 6a true and correct All pmvi;ions of laws and <br />ordinaces govaming this rype ot v,ork will bo complied with whothor spec�ed herain or noL Tho grantinp oi a portnit does not pros�n <br />to glve authoriry to violate or cancel ihe provision of any other stata or local law regulating construCtion or tho perturmznce ot <br />constmetion. That I am a ihorizod by lhe o� er oFUus p erty to pedorm the work forwhich appliqtion is made and I comply with <br />Sk Con C(or 1^ F}CVy a�29F 00 WAC- p <br />���� � iJ 0=�p,'-z �� e4'�L.,rr-�11- c..r S-CK� Cfj3L�. �i <br />Sinnaiisa� of Ownod�a /A�theri�ed Aaem flatn �•�L�'«� �� ��� <br />� <br />� <br />i I _ �Y"l� �t: �j <br />-1Ui11'���I�f��,�� Iv <br />