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SOCi <br />SITE ADDRESS <br />i� SG Gverett Mall <br />IEGAL LOT NO. <br />DESC. AtY8CY12CI <br />Robinson Properties <br />TENANTNAME <br />PERMIT APPLICATION <br />CI'TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -�vww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRpM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />28051800305000 <br />TRACT <br /># <br />/��C�U� <br />500 SE Everett Mall T�Tay Everett, 98208 (425) 353-8400 <br />CONTACT FOR PERMIi <br />PHONE <br />Keller-[Jilliams Realty � Adam Clark/Gary Parkinson Architects (425) 252-2153 <br />CONTRACTOR A�DRESS CITYIZIP PHONE <br />To be determined 7onh R-U�I'we� Rvlr- �nc• /hw�1�UJjL Cjb2�0 Q2S 3b�iSS <br />CONTR. LICENSE # �k 36 0 6 SZ 23°) �- <br />USE Of BUILDING <br />Business <br />WORK DESCRIPTION <br />HEATSOURCE <br />x Eiectric _ Gas _ Other <br />Tenant improvement of second floor and lobby at first floor. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sinl; (servicelbadmop/etc.) <br />Bad:flow prevent2r <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />CONTRACT PRICE OF WORK <br />$100,000.00 <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whelher specifed herein or nol. The granting of a permit dees not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />wnstruction. That I am aulhorize�l by the owner of this propeA� to perfortn lhe work for which appiication is made and 1 comply wiih the <br />Stat Contractors Law 182 RGW and 96.200 WAC. <br />� U� ��-�c /� <br />Signa of OwneqContract /Authorized Agent Date `I�//' +' <br />�J <br />