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� <br /> �-�g i� - �t��� N P <br /> P�R�1�ITi APP�l��^►.�IQi�I <br /> CITY OF E�Ii.RETT PER��[Il' 5ERVIC�S <br /> 3200 GEDAR �;TR�ET, EI�CRETT, �VA 932vi y� _ a� _�� <br /> 425-257-8810 -FAX 425-257-�fi57-wv,w.e.�ereY,wa.ory <br /> APP[.ICATICNS ARE ACC�P7k7 F�i�?5! �.4i�5 T'v d PPoi f%W b (�- Qa�� <br /> SITE ADDRESS I F�:tRCEL i'l.?:f.R.# I P,�RM�T# <br /> 4935 tivergreen Way, Gverett L l'05819000�Gi00 �� jj(��'"a� <br /> LEGA LOT N0. BLOCK TR4,CT OR SU9DIVISION# <br /> DESC. 5 ❑ h Niw�v Add BI,K 000 D-00, lots 1 thru 13 <br /> OWNER ADDRESS � CITY2IP PHONE <br /> Isador SchreiUer & Associa[es, LLC 65G Orcas St /1210, Sea[tle, ldA 98108 206-658-3104 <br /> TENANTNAME CONTACTFORPEHMIT PHONE 425-348-7100 <br /> QrC IJohn Anthony, Community transit hn.anthony@commtrans, rg <br /> E•M�. <br /> CONTRAC O ADDRESS CI I 0 <br /> TBll <br /> CONTR.LICENSE q <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> IIus Shelter I _Electric _Gas�OtherN/A � � 55i �g� <br /> WORK DESCRiPTION <br /> Remove esisting pavement and existinF site improvements as necessary, <br /> insCall raised transit pla[form, insLall necessary infrastructure, erect shelter <br /> strucl-ure and install needed amenities. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FlXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel NC-air handling units <br /> Balhlub _ Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater Fange hood <br /> Sink(service/bar/mop/e�c.) _ Exhaust(an <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit hea�er <br /> _ Drinking�ouNain Boiler <br /> Floordrain _ Relrigeration <br /> Grease trap _ Woods�we <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined lhis application and know the same to be true and correcl. All provisfo.is ot laws and <br /> ordinaces governing ihis lype of work will be complied with whelher specified herein or noL The granling of a permit does not presume <br /> to give authority to vfolate or cancel lhe provision of any other state or local law regulating construction or the performance of <br /> construction That I am auth rized by Ihe owner ol lhis property lo perform lhe work(or which application Is made and I comply with the <br /> S�ate Contra�tor�Law78:27 RCW and_296.200 WAC. � <br /> �f;,� ,, 7 �ov s <br /> Signatu� o Owner/Gontractor/Aut rized Agenl - '�Date i/ <br /> ( � <br />