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SITE ADDRESS <br />15 SW Everett Mall Way <br />LEGAL LOT N0. <br />DE SC. See dYYdCh2d <br />NERMIT APPLICATI�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8870 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARC[L TAX I.D. N <br />28042400100300 <br />BLOCK I TRACT OR SUBDIVISION q <br />g -- �y �/� <br />� /Gt� o -d� <br />PERMIT q <br />vo�- r,�� <br />PHONE <br />EVERETT PROJECT LLC �� 2256 38TH PL E--- SEATTLE, WA 98122 <br />TENANT NAME CONTACT FON PERMIT PHONE 425-776-8835 <br />Molina Medical Tracie Skiles newpermits@berryneonsigns.com <br />e-Mnu <br />CONTRACTOP ADORE55 UTY21P PHONE <br />BERRY NEON SIGN SYSTEMS 7400 Hardeson Rd, Everett, WA 98203 425-776-8835 <br />CONTR. LICENSE N BERRRYNC077CM � <br />USE OF BUILDING <br />COMMERICAL <br />WORK DESCRIPTION <br />N0. <br />INSTALL 2 lit wall sign <br />PLUMB <br />TYPE Of- FIXTURE OR ITCM <br />Toilet <br />Dathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />W ater heater <br />5 ink (serviceiUar/mop/etc.) <br />6ackllow preven[�•r <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />R oof drains <br />Other <br />HEATSOURCE <br />___ Eiectric ___ Gas __ Other <br />N0. <br />CONTRACT PRICE OF WORK <br />$1852 <br />TYPE OF FI%TI�RE OR ITEM <br />A/C - air handlin9 units <br />Forced air systems <br />Gas pipin9 <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />R e(ri9e ra tlon <br />W oods tove <br />Other___________ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that 1 have read and examined this applica6on and know �he same to be true and correct All provisions of laws and <br />ordinaces goveming this type o( work will be complied with whelher specified herein or not The 9ranGng of a permit does no[ presume <br />lo give authoriry ro violate or cancel the provision of any other s[ate or local law regulating construction or the per(ormance of <br />consUu on. That I am authorizecl by the owner oF this property to perform tlie work for which application is made and I comply with ihe <br />StateL�%n�dors Law 1817 RCW and296.200 WAC. , <br />��2 <br />