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� r <br /> ��cRMIT APPLICATIuN � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W/�98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCc'L TAX I.D.# I PERMIT Y <br /> 215 [3ARBARA LANG r� ��/ ` U/C� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE � <br /> ci.r:No�iN��e,�L� ���r,��a,�;� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> KBN RODINSON-fI.MSLIE (360)403-7462 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ROf31NSON PLUMf31NG IMC. 39330 124111 AVf N,G. ARLING"ION 98223 (3ti0)A03-74G2 <br /> CONTR.LICENSE N k0-f31-NI'-'272C2 . <br /> USE OF BUILDING HEAT SOURCE GONTRACT PRICE OF WORK <br /> SINGLG FAMILY Rf?SIDBNCG _Electnc _Gas_Other I �3500 � <br /> WORK DESCRIP710N I <br /> INSTAI.I.PIRfi SPRINKLI:R SYSII'M IN NIiW Sllt <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilnt A/C–alr handling units <br /> _ Bathtub Forced alr systems <br /> _ Lavatory(wash l asin) Gas piping <br /> _ Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ C�othes washer Clothes dryor <br /> _ Laundry tray Range hood <br /> Sink(service�6ar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump� <br /> I _ Unnal _ Unil heater <br /> Drinking Founta�n 6oiler <br /> Floor drain Refrige�a!lon <br /> I _ Grease trap Wood:tove <br /> Roof drains Other <br /> � Other — <br /> �— ..'T•' �1'R11CKtt'R-tiMMf!r— <br /> �I <br /> � CITY OF EVERETT LOCAL SALES TN(CODE 19 7103 <br /> I hereby ceritify that I have read and axaminee this application and know the same to he Irue ana correct. All provisions of laws and <br /> � ordinaces governing thls rype of work will bc �:omplied H•ich whether specified herein or not. The granting of a permit does not presume I <br /> to give authonty to violate or wncel Ihe provision ot any other state or local law reg��lating construction or the peRortnanca of � <br /> � construction. 7hat I am authonzed by the owner of this property tu peRorm the work for which aVplication is made and I cc�nply with the I <br /> State Conhactors La 18.27 R and 296200 WAC. � <br /> `�.,� �' f1�5�� <br /> SignaNre o wnerr ontractonAuthonzed Agent ate <br />