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�- i �- �> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS PARCEL TAX I.D.# P RIjIIT# � <br /> 1021 SG CVERGT'P 1�1ALL WAY, IILDG"G" ��j/,�� -� <br /> LEGPL LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNER � AD�RE55 CITYIZIP PHONE <br /> COE3I3L�STONE COTTAGG F10MGS, I.L.0 1312 G LAKGSHORG DR LAKE STL-VENS 9R258 (206)40G-1213 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> KEN ROBINSON-C-LMSUE (360)403-7462 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ROI3INSON PLUA1BWCi INC. 29330 124TH AVE N.E. :iRLINGTON 98223 (3G0)A03-7-062 <br /> CONTR.LICENSE p It0-I31-NP-�27?C2 <br /> USE OF BUILDING — HEAT SOURCE I CON"�<ACT Fr210E OF WORK <br /> SINGLG�AMILY RESIDENCG Eleclric Gas Other 52035 <br /> WORK DESCRIPTION <br /> INSTAI.L�IR6 SPRtNKLER SYSTEM W NGW SFR <br /> PLUMBING MECHANICAL <br /> NO. TYPE bF 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 /> Snower Water heater <br /> Kitchei sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust(an <br /> Back(lowpreventer _ Heatpump <br /> Unnal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other In SPRINKIJ;R III'.ADS <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions o�laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not The�renting of a permit does nol presume <br /> to give authonry to violate or cancel lhe pmvision of any other state or local law regulating cortsWction or the perfortnance of <br /> construction.That I am authonzed by the ownar of this property to perfortn the work forwhich application is made and I comply wilh Ihe <br /> State Contrectors Law 18.27 RCW end 296.200 WAC. <br /> /. <br /> �_����� �� ���`� �� ' ' ll "I �t �: � <br /> Signature of OwneNContractodAuthonzed Agent Date <br />