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i <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />910 SE Everett Mall Way <br />28051800306100 <br />lig4gq=@51- <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITY/ZIP PHONE <br />Madison Development Group 10510 NE Northup Way Ste 120 Kirkland, WA 98033 425-889- <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Greg Nelson 360-770-1006 <br />I <br />CONTRACTOR ADDRESS CITYMP PHONE <br />Impero Contracting Co., LLC 1971 Midway Lane Suite N Bellingham, WA 98226 <br />CONTR. LICENSE 0 <br />360-733-7052 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />Retail <br />I <br />I <br />— Electric Gas Other <br />$900,000 <br />WORK DESCRIPTION <br />Plumbing Installation <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ <br />A/C — airhandlingunits <br />Bathtub <br />_ <br />Forced air systems <br />—l_ <br />Lavatory (wash basin) <br />_ <br />Gas piping <br />_ <br />Shower <br />Water heater <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />_ <br />Gas range <br />_ <br />Clothes washer <br />_ <br />Clothes dryer <br />_ <br />Laundry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />_ <br />Backflowpreventer <br />Heat pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />Drinking Fountain <br />Boiler <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other_ <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 governing this type of work volt be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. Thatl am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contra taw 18.2.7RCW and 296.200 WAC. <br />—' 3/17/05 <br />Signature o ea ontractorlAuthorized Agent Dale <br />Impero Contracting Co., LLC <br />-Tok <br />