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y <br /> l <br /> l � <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 � Z �a��Qb <br /> SITE ADDRESS PARCEL TAX I.O.N P��tM1T k <br /> 1715 Broadway Avenue 00438235200300 �L�I� �� <br /> l[GAl LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS � CITY2IP PHONE <br /> Safeway 1371 Oakland dlvd , Walnut Creek , CA 94565 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Safeway I Connie Guffey ( 253)973-3323 x10 <br /> CONTRACTOR ADDRESS CITY2IP F`HONE <br /> Plumb Signs Inc. 909 S. 28th St . , Tacoma , 98409 ( 253 )473-3323 <br /> CONTR.LICEN3E S <br /> PLUMBSI077QS <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Grocery Retail _Eleclric _Gas__Olher $h � 125.00 <br /> WORK DESCRIPTION <br /> Remove existing signage ior Safe�aay and install new. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIKTURE OR ITEM NO. TYPE O�FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Cas piping <br /> Shower _ Wnterhenter <br /> Kitchen sink 8 disposel _ Gas firepl2ce <br /> Dishwasher Gaarango <br /> Clolhes washer Clolhes Oryer <br /> laundry tray _ Range livod <br /> Sink(service/bar/mople�c.) _ 9xhausl fan <br /> �ackflow prevenler Heat pump <br /> Urinai Unit heater <br /> Drinking Fountain _ Doiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drai�s Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J705 <br /> I hereby ceritify Ihat I have read and examined lhis application and know lhe samo lo be trur,and correcl. All provisions of laws and <br /> ordinaces goveming lhis type of work will be compiled wilh whether spedfied hereln or not.The grenting of a portnit doos not presume <br /> to yive authorily to violato or cancel ihe provision of any ofher slate or local�aw reguialing construction or Ihe pArformanco of <br /> construclion.That I am aulhorized by the owner of Ihis property lo perform the work for which application is ma�ie and I comply with the <br /> Slate Conlraclors Law 18.27 RCW and 29G.200 WAC. <br /> � �/�,u./,l,w �z���6 <br /> Signature of wnedContr�jdFulh ed Agont /Deler � <br /> �l/ Z <br /> � -- _ — <br />