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, � 2B16 - rb�'.�h <br /> c <br /> PERMIT APPLiCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET[', WA 98201 � � �� <br /> 425-257-8810- FAX 425-257-8857--www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P� �O�� ��G <br /> SITE ADDRESS PAFiCEL TAX I.D.# I �RMj;# - �S <br /> 5002 Evergreen 1Jay, Lverect 00581900002800 j �j O� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION R <br /> oESC. South Hiway Add BLK 000 D-00, lots 28-53 <br /> OWNER AODflESS ' CITY2IP PHONE <br /> c/o 1200 Sth Avenue 111711 <br /> �r�e�� t��v Holdin�, T.T,C Seattl.e, ldA 98101 206-515-4500 <br /> TENANTNAME CONTACTFORPERMIT PHONE 425-348-7100 <br /> john.anthony@commtrans.org <br /> Rite Aid John Anthony, Community T[ansitE•MAIL <br /> C TRACTOR DDR SS CI 2 O <br /> TQD <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> IIus Shelter _Electric _Gas,�Other N/A '� Z��j, �(,��y <br /> WORK DESCRIPTION <br /> Remove existing pavement and existin� site improvements as necessary, <br /> install raised eransit platform, insCall necessary infrastructure, erect shelter <br /> sCructure and install needed ameniCies. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlICTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC—zirhandlingunits <br /> � Bathtub _ Forced air syslems <br /> _ Lavatory(wash basin) _ Gas plping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinai _ Unil hecder <br /> _ Drinking Fountain _ Boiler <br /> Floordrain _ Ref;ig?raUon <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordin�ces governing this type of work will be complied wilh whether specified herein or nol.The granting of a permil does not presume <br /> to�ive authority to violate or cancet the provision of any olher state or local law regulating construction or the pedormance of <br /> consWclio That I am authorized by the owner ol this property to perform the work(or which appiication is made and I wmply wilh Ihe <br /> Slate Contra tor av�(8.2 R�W an 296.200 WAC. <br /> �� j �� �7 j z�.r, - <br /> Signatur of OwnedCoi tractodAuthoriz�d Agent / Date �/� <br /> / 7 <br />