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� <br /> , PERIVIIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S'i REET, EVERETT, WA 98201 <br /> 425-257-8610— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PER671T# l � <br /> 1613 47TH 5"f <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNEN ADDRESS qTYIZIP PHONE � i <br /> ao�ra r KiNcnin � <br /> TENANT NAME I CONTACT FOR PERMIT PHQNE I <br /> KEN ftOI3INSON-ELMSLIE (360)403-7dG3 i <br /> CONTRACTOR ADDRES5 CINIZIP PHONE I <br /> OI3INSON PLUMBING INC. 29;30 12dTII AVG N.G ARIJNGTON 9S?�3 (360)403-7-162 ' <br /> CONTR.LICENSE iR�'BI-NP-*27?C2 I <br /> USE OF RUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 'INGLI� PAMILY RGSIDGNCG �Electric _Gas_Other S499i <br /> WORK DESCRIPTION <br /> NSTALL PIRH SPRINKLGR SYS'fEM W NGW SFR � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TL1P.E OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I = Toilet = A/C–air handling units II <br /> Bathtub Forced air systems i <br /> Lavatory(wash basin) Gas piping � <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(servicerbadmop/etc.) Exhaust fan � <br /> _ BackFlow preventer _ Heatpump I <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> _ ROOf dfBinS .y�—tiR��u�L��� <br /> �ther <br /> CIN Or EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read ard examined this application and know the same to be true and corcect. A'I provisions of laws and i <br /> ordinaces governing this type of work will be complied wiih whether specified herein or noL The granhng of a pertnit does not presume <br /> to give authority to violate or cancel the prov,s�on of any other state or local law regulating construction or t��?oeRormance of i <br /> construction. That I am authorized by the ox�ner of tBis property to pertorm Ihe work for which application is..•ade and I comply with the <br /> State Contr��awr�827 RG141 and 296200 WAC. <br /> � -t�J Iu/�/„ <br /> Signature of Owner/Contractor/Au[horized Agent Date � <br /> I ,! <br />