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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EYEF7ETT,WA 98201 I <br /> 425-257-8810—FAX�125-257-8857—www.everetN+a.o!g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE35 PARCEL TAX I.D.� PERMR I1 <br /> 11120 Evergreen Way. Suites E & F 00442900300700 '� C+(;/,7� '� �� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. part of Lot 13 Fafrmount <br /> OWNER ADORESS CITY2IP PNONE <br /> Ever ray Pro ertles, LLC �/o: Coast Reai Estate Servlces, 2829 425 339-3638 <br /> g p Rucker Ave., Suite 100, Everett WA 98201 � / <br /> TENANT NAME I CONiACT FOR PERYIT COnt3Ct fo�Plefl REViEw: PHONE <br /> A. Byron Balogh, Balogh Arciiitecture <br /> Maly'S 11379 SW f_anvasback Way, Beaverton OR 97007 (503) 579-4546 <br /> CONTRACTOR AODRESS C1TYf�F PHONE <br /> Jason Pearl, Pearl Construction, LLC 13206-A2 N.E. Fourth Plain <br /> CONTR.LICENSE M Vancouver, WA 98662 360 256-5779 <br /> PEARLCL993Q8 3;,�,,,Z.� 5�-�c� � ) <br /> USE OF BUILDING —_ HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> RetailSales Ekctric X Gas_Other �L� ��(os <br /> WORK DESCRIPTION <br /> 2,600 SF in[erior fenant Improvement within existing reta(I bullding. Rearrengement of interior walls, doors, etc. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF flXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet AIC—air hendiing unRs <br /> Bathtub Forced air systems <br /> Lavatory(wash basin� _ Gas pip!ng <br /> � Shower Water heater <br /> Kitchen sink 8 tlisposel _ Gas fireplaa <br /> Dishwasher Gas range <br /> � Clothes wasber Clothes dryer <br /> Laundry trey _ Range hood <br /> Sink(servicelbadmopletc.) _ Ezheust hn <br /> BadcHow preventer _ Heat pump <br /> Urinal Unfl hea[er <br /> Drinking Faunlain _ Boikr <br /> Floor drein Refrigeretion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CIT`/OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> I hereby cerilify that I have read and exemined lhis appliwtion and know the same to 6e true and corred. AH provisions of laws and <br /> ordinaces goveming t ' of work will be complied with whether spetified herein or not The granGrg cf a pertnR does not presume <br /> to give authority to vi ate or ncel lhe provisbn of any other sfa!e o�Iowl law regulaUng consWetlon or the perfoimance of <br /> consWdi I autho ed by the ownar of this property to peRortn ihe woAc for which application is made and I comply with the <br /> Slate Con do L 18.27 CW and 296200 C. <br /> �f�W.-�.U�ISi� u.1/ <br /> Signaturc u/Contractor/Authorize Agent Date <br /> 'i� I <br />