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PERMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-- FAX 425-257-8857 —�wwr.eoerettwa.org <br /> .7���k __ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �-�a--v 7 <br /> SITE ADDRESS PARCEL TAX I.D.p P IT 11 <br /> ,.J.4.2�4 Cascade Urive 0039360020(Ni00 `�'�(�.'�� -�L� <br /> LEGAL LOTNO. 6LOCK TRACT <br /> D[SC y (H)1 ReVCCI HOrtle D1V 1 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Roys C ('irls Club 4322 Rucker Ave f?veret[, 98203 (425) 258-7.436 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Sarne �s al�ove Gnry Parkinson, Archi[ccts (425) 252-2153 <br /> CONTRACTOR ADORESS CITYILP PHONE <br /> 'I'ci be deLerniincKl ^��� ��—� <br /> CONTR.UCEN9E� ,,,� �- - - - — v <br /> 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Re�creatinn x Giectric _Gas_Other $25,0(X) <br /> WORK DESCRIPTION <br /> New floor and oCher. rninor repnirs. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE Of FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> BaUiwb Forced air syslems <br /> Lavatory(wash basin) _ Gas pipicg <br /> Shower Water healer <br /> Kitchen sink 8 disposnl _ Gas freplace <br /> Dishwashcr Gas range <br /> Clothes washer Clothes dryer <br /> Laundry Uay _ Range hood <br /> Sink(servicelbaqmopletc) _ [xhaust fan <br /> 6ackilow preventer _ Heat pump <br /> Urinzl Unil healer <br /> Drinking Fountain _ Ooilcr <br /> Ploor drain Refngcration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher _ — <br /> CITY OF EVERBTT LOCAL SALES 7AX CODE IS]705 <br /> 1 hereby ceriliry that I have read and examined lhis npplicalion and know Uie same lo be true and corted. All provisions ot lavrs and <br /> ordmaces governing this type ol�vor will be complied with whether specifed herein or nol The granting ol a permit does not presume <br /> to give aythorily lo violate or Can�ie,piovision ol nny other slale or local law regulating construction or the performance ol <br /> consirudion That I am authonze�l�y�he owner of this property to peAorm lhe work lor which epplication is made nnd I comply wilh!he <br /> State Cbnlraqws Law 1D 7 RCW a�(d 2�i200 WAC. <br /> // I � <br /> ' �� ,-�� �V � L� ' � • Z�,��G' !_-. <br /> SuinaWrqgl wn dContractorlAuthorized�gent Date T <br /> �, �/2 <br />