1130 BROADWAY MORENOS 2016-01-01 MF Import

P�r�MIT APPUCATIC�-�J CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 425-257-8810 - FAX 425-257-8857 SITE ADORESS PARCEL TAX I.D.N PERMI7 M 3� Q o2C7q-�/� LEGA LOT NO, BL TRACT � DESC. OWNER AUDRESS ZIP PMUNE � �n�G�ci�'s �(� s i c° �- (�i�ti �H�s--�-�2� TENANTNAME � �,/ ��/[ C� / '!�✓ ,�0� I CONTAC�/ 7� � i PHCNE CONTRACTOR ADDRESS ZIP CONTR.UCENSE N PHONE PROPOSED USE OF BUILDING I""1 Building I7 Mechanical Addition HEAT SOURCE PERMIT F.� Combination ��Plumbing WORK Alteralion Elearic I TYPE �l L'omolition LJ Sign TYPE New Gas L.) Sprinklrr Repair/Maint. Other CONTRACT PRICE OF WORK CRY OF EVERETT LOCAL SALES TAX COCE IS 3105 WORK DESCRIPTION ��-P-ta�i.t.. �.cY�a. �'Y�Qe/wn�.�.�m� PLUMBING MECHANICAL N0. TYPE OF FIXTUHE OR REM NO. TYPE OF FlXTURE OR ITEM I _ WATERCLOSET _ A/C—A/HANDLINGUNITS i _ BATHTUB _ FORCED AIR SYSTEMS _ LAVATORY(WASH BASIN) _ HEAT PUMP SHOWER _ UNIT HEATEFS K�TCHEN SINK 8 DISPOuAL _ CLOTHES ORYER _ D!SHWASHER � RANGE HOOD _ LAUNDRY TRAY _ WATER HEATER _ CLOTHES WASHER _ METAL FIREPIACE/STOVE _ UP.INAL _ FIREPLACE INSERT _ DRINKING FOUNTAIN _ GAS FIREPLACE _ FLOOR DRAIN GAS RANGE BACKFLOW PREVENTER � GAS PIPING � = SIiVK (SGRVICE.�6AR/MOP/ETC.) _ EXHAUST FAN I _ OTHER_ — __ OTHER I — — _ I —I _I � I HEREBY CERITIF`/7HAT I HAVE READ AND EXAAI:NEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVIS�ONS OF LAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY OTHER I STFTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNEE3�F...I}]LS PROPEtiTY TO PERFORM1t THE WORK fOR WHICH APPLICATION IS MADE AND�COh7PLY WITH THE STATE � 00NTRACT�S�LA t8.27 RCW AND 296.200 WAC. �� /�'—�S-6 2 Signature ol OwneuConlractoNAut ionzed Ag t Date 1/ L