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SITE ADDHESS <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -• FAX 425-257-8f157 - www.everettwa.org <br />A�PLICATIONS ARE .4CCEPTED FROM 8 AM 70 4 PM <br />4?G \YOOI�I.AN'N .\VI: <br />PARCEL TAX I.D. R <br />LOT NO. I BLOCK I TRACT OR SU6DIVISION M <br />fIRSI' PI IASG CONSIRUCI ION <br />3�3-��. <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />I:I:N R0I31NSON-GI.MSLIIF.Mpi�(36i1j403-7d62 <br />r <br />KUBINSON PLUh1131NG WC. 29330 12d'lll AVI: i:.c. ARI.ING"I'ON 982?= 1360}303-7dG2 <br />CONTR. LICENSE p �LO-BI-NI'-�27?C� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />INSTAi.I. I'IRL SPKINhLL'R SYS'1'IiM IN Nli\1' SPK <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toile� <br />Bathtub <br />Lavalory (wash basin) <br />Sho�•ver <br />Kilclien sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/etc.� <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other _ <br />HEATSOURCE <br />Electric Gas Olher <br />C�ONTRACT PRICE OF WOflK <br />5+.770.00 <br />N0. I TYPE OF FIXTURE OFi ITEM <br />A/C — air handling uni�s <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas lireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit hea�er <br />Bailer <br />Relrigeralion <br />Woodstove <br />Other <br />Tr-I SPlaert7'trnr,ros— <br />CITY OF EVEflETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have rrad and examined ihis application and know ihe same to be Irue and correct. All provisions of laws and <br />ordinaces goveining Ihis rype of woik will be complied with whe�her specilied herein or not. The granting of a permit does not presume <br />to give authority to violate or cance� the provision ot any other stale or local law regulating conshuction or the perlormance ol <br />construclion. Thal I am authorized by Ine owner ol Ihis propeny ro pedorm Ihe work �or which application is made and I comply with the <br />Slate CoNractors Law 1827 RCW and 296.200 WAC. <br />i <br />�:."��l�1-• i� ''.i1:J/�JL: <br />Srcjnalure of OwneriConlractoUAuthonzetl Agenl a� �e <br />�IZ <br />� <br />