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� <br />� � �,G�� . � �S{ C� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 a� <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org y'- "� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �G� 1 G�- I3 <br />SITE ADDRESS PARCEL TAX I.D. # PER IT # <br />4102 Rucker Avenue, Gvcre[t 00582101402502 � 0 J�-� j <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION k <br />DESC. South Park Add [o Gvere[c I3LK 014 I)-02, i.ocs 2fi-30 <br />Safr_way Inc., 1371 O�kland Ulvd (l200, Wa1nuC Creek, CA 9859G Sl0-SGS-3934 <br />TENANTNAME CONTACTFORPERMIT PHONE4?5-348-7100 <br />Sa[eway ,'.t443 .1ohn Anthony, Communi[y 'Cr�nsi.E•��im..�ntliony@comm[rans. <br />..........._._.. T�in <br />CONTR. LICENSE Y <br />USE OF BUILDING <br />Ilus Shcl Ccr <br />HEATSOURGE <br />_Eleclric _Gas �,.Other ;��p <br />CONTRACT PRICE OF WORK <br />1 �,- -1 _: �i,, <br />1 � <br />WOHK DESCRIPTION <br />Removic exisCin{; pc�vement and exi.sCin}; sLLe impcovements as necess�ry, <br />insCal] r�i.ticd lr:msi.� p1aCCorm, ins[all necessary i.nfrascruccure, erec[ sheleer <br />SCrucCuro and insCnll necded :�menicicv. <br />NO. I TYPE OF Fl%TURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen slnk & disposal <br />Dlshwasher <br />Clothes washer <br />Water healar <br />Slnk (serviceNadmo��etc.) <br />Bnckllow proventcr <br />Urinal <br />Drinkinp founlain <br />floordraln <br />Groaso Irap <br />Rool drain, <br />Olher _ <br />N0. I TYPE OF Fl%TURE OR ITEM <br />NC - air handling unils <br />forted air systems <br />Gas piping <br />Watcr healcr <br />Gas Greplace <br />Gas rango <br />CloUies drycr <br />-- Hanpc hood <br />Ezhaustlan <br />Hcat pump <br />Unit hcater <br />Doiler <br />FiMriperation <br />Woafstove <br />Other <br />dTY OF [VERETT IOCAL SALE9 TA% COOE IS 9103 <br />I horeby wrllily that I havo ranJ and examined Ihla applicnlion and know the cama lo bo truo and corrocl. All provlsions ol laws ond <br />ordinacas poveminp Ihle typa ol work will bo eompliod w�lh whctlier specilicd hcroin or no�. Tho pranting of a pormit dooa not prosumo <br />lo pive nulhorily to violale or cancel ihe provmion ol ony olher sWte or local law repul�linp conclrucUon or Iha poAormanco ol <br />conslruGion. lhal I am nulho�imd by �hn owner ol lhis property lo parlorm �ho work lor which appllcaUon is mado nnd I comply wilh Iho <br />Stata CanV� clofa Lnw 1027fIGW vu129G.200 W�C. <br />�� � /� �' .� � i�.- ..�, �. <br />. C <br />Ipnaly a o Ownm/ onlraclor/Aullwryr�d pont / ��— / I <br />/ ` <br />