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i <br /> PERMIT APPLIC,ATIO►N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIGVS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.1t PERMIT N � <br /> 4606 STH AVE W ' O� — � <br /> BLOCK TRACT <br /> LL-GAL LO1N0. <br /> OWNER AD�RESS CITYIZIP PHONE <br /> WITHERS CONSTRUCTION <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Ken Robinson-Elmslie (360) 403-7462 <br /> coNrstncroR Robinson Plumbing Inc ADDRESS CITYri' PHONE <br /> CONTR.LICENSE# RC91N"272C2 2�"'0 124ih Ave NE Arlingtan 98223 (360) 403-7462 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Single Family Residence Elearic Gas other S268 <br /> WORK DESCRIPTION <br /> Install fire sprinkler system in new single famiiy residsnce <br /> PLUMBING MECHANICAL <br /> N0. TYPE�F FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM . <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash bas�n) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> 15 rinkler Heads <br /> C�TY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application antl know the same to be true and cortect. All provisions of laws and <br /> erdinaces governing this type of work will be complied with whelher specified herein or nol The granting of a permit does nol presame <br /> to give authonly lo violate or cancel the provision of any other state or local law regulating constrdction or the performance of <br /> construction. That I am authorized by the owner of this propeAy to perform the work for which application is made and I comply with ihe <br /> State Conlractors Law 1827 RCW and 296200 WAC. <br /> a� �' 21, s ���� <br /> Signature of OwnedCoNradodAuthonzed Agent Date ���� <br />