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J� ����� ` ��l'i�� NU <br />; <br />PERMIT APPLICA i ION <br />CITY OF EVERETT PERMIT SERVIi:ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-6857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />q � a� y —or'1 <br />P� a�og -r a-- <br />SITE ADDRESS PARCEL TA% I.D. # I P�ERM p <br />3929 Rucker e\venuc, Evere[C 00411300501300 /) f%�'��L' <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION X <br />DESC. GvereCt I�LK. 005 �-00, l.ots 13,14,15,16, LG ]ot 16, BLKS <br />OWNER AODRESS CITY2IP PHONE <br />The CvereCt Clinic 3J01 Iluyt elvenuc, I:verett, 1JA 98201 425-259-11G3 <br />TENANTNAME CONTACTFOfl PERMIT PHONE 425-348-7 00 <br />johnan[hony(�commtrans.oi� <br />The Evcrett Clinic �.Iohn e\nthony, CommuniCy Transi'£-MAIL <br />R I�FTUAE-- <br />'� BD <br />CONTR. UCENSE p <br />USE OF BUILDING <br />6us She].Ccr <br />HEATSOURCE <br />Eleclric _9as,�,Other ��p <br />CONTRACT PRIGE OF WOHK <br />� 2�'3, `l ��� � <br />WORK DESCRIPTION <br />Removic e�:isCing pavement and eaiscing sice improvements as necessary, <br />insCal.l raised transi.c piatform, insCall. necessary infrastruc[ure, erect shelter <br />strucCi�rc and install needed amenities. <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (semce/badmop/elc.) <br />BackOow preventer <br />Urinal <br />Drinking Fauntain <br />Floor diain <br />Grease trap <br />Rool drains <br />Other <br />NO. � TYPE OF Fl%TURE OR ITEM <br />NC - air handling units <br />Forced air systems <br />G�.s pipinp <br />Water I�eater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust lan <br />Heal pump <br />Unil healer <br />Bailer <br />Felrigeration <br />woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CO�E IS 3105 <br />I hereby ceritity thal I have read and examined th�s application and know Ihe ssme to be true and correct. All provisions of laws and <br />ordinaces 9o��rning this type of work will be complied wilh whether specified herein or ��t. Thc granting ot a permit does noi presume <br />to give aulhoriP� to violale or cancel the provision of any olher slate or Iocal law regula... �g construction or the pedormance of <br />co�sWclion. lhat I am authorized,by the owner of lhis property lo pertorm Ihe work for which application is made and I comply wilh the <br />Stale Con act rs Law 18R7 �., d296200 W�C. - <br />— � �" i: � <br />� � ;; % , <br />i� /�� z ; .<<, ; <br />Sipn�Jre o� OwnedConiractod ihonzed Agent `"" / Date �/ <br />Y <br />