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i-i � -c�; <br /> PERiVl17 APPLIC�TION <br /> CITY OF EVERETT PERMIT SERViCE� <br /> 3200 CEDAR STREET, EVERETT, WA 9820? <br /> 425-257-8810 —FAX 425-257-8857 —www.everett�ia.org <br /> APPLICATIO�S ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT <br /> 1021 SE L-VL-RETT MALL WAY, E3LDG"E" I I ��l �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE <br /> C,J136L8S"1'ONH COTTAGL f IOR1E5,LLC 1312 G LAKCSI IORE DR LAKL STGVENS 98258 (20G)406-1213 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � <br /> � KGN RODINSON-ELMSLIE (360)403-7462 <br /> CONTRACTOR ADORESS CINIZIP PHONE <br /> R0131NSON PLUMI3ING INC 29330 124TH AVE N.E. ARLING'fON 98323 (360)403-7462 <br /> CONTR.LICENSEA RO-I3I-T�P-'272C2 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SINGI.IiPAMILYRBSIDGNCE _Elednc _Gas_Other $2035 <br /> WORK DESCRIPTION <br /> INSTALL PIRG SPRINKLER SYSTFM IN NEVV SFR <br /> PLUMBIfdG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&dis;.osal Gas fireolace <br /> Dishwasher G2srange <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaustfan <br /> Backflowpreventer _ Heatpump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refngeretion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other 10 tiP18NF:Llili IIIiAI)s <br /> CITY OF EVERETI'LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this application and know the same to be Irue and cortect. All provisions of laws and <br /> ordinaces goveming Ihis rype of�wrk will be complied wilh vhether specified herein or not.The granting of a permit does not presume <br /> to give authonty to viola�e or cancel the provision of any other state or local law regulating consWclion or the performance of <br /> consiruction.That I am authorized by the owner of this property to peAorm the woric tor which application is made and i comply with the <br /> State Contradors Law fi8,27 RCW and 296.200 WAC. <br /> . . '. :, /. � i <br /> � ' � <br /> _`_i '\ � (_� : 6—i I � � I ( Date <br /> Signature of OwnedContracfor/Authonzed Agenl <br />