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15 SW EVERETT MALL WAY MOLINA HEALTH CARE 2016-01-01 MF Import
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15 SW EVERETT MALL WAY MOLINA HEALTH CARE 2016-01-01 MF Import
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Last modified
4/11/2017 9:06:36 PM
Creation date
2/10/2017 2:12:22 AM
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Template:
Address Document
Street Name
SW EVERETT MALL WAY
Street Number
15
Tenant Name
MOLINA HEALTH CARE
Imported From Microfiche
Yes
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SITE ADDRESS ' <br />I J S.�/`� . L � <br />LEGAL LOT NO. <br />DESC. <br />i <br />� <br />PERMIT AP'PLICATION <br />CITY OF EVERET'T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42�-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />� <br />APPLICATIOMS ARE ACCEPTED FROM S AM TO 4 PM <br />BLOCK <br />� <br />�.,�r��Tr r����r, c.�� <br />TENANTNAME <br />�- �: rJ 2 ''1 FJ�IT Ll��.�- <br />C NTRACTOR � <br />I�w�Ct AC.i Y�Y. <br />CG�J•��. �E - <br />CONTR. LICENSE # <br />Tc�.,crL Pc � <br />USE OF BIJILDING <br />lTa-�r�NT— �Co�cc�c. <br />G f� i.+ i t <br />PARCEL T!J( I.D. it <br />OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />�- <br />i�,� I.,�nF� <br />�>:i �" . a�A�i� �vaN <br />i� (�l 3 3t-� <br />HEATSOURCE <br />_ Eleciric � Gas _ Olher <br />9 —YU /� <br />PERMIT # /� <br />/� /O�G "O°� <br />PHONE 3�0 — �► 2 y—� <br />3EL�—[oCnl 'OS 3 <br />�ur rn�no • c u•-� r <br />ML`Jt�'i�c^2r1dJ' W A <br />2ti273 <br />�2� 6� •� I <br />CONTRACT PRICE OF WORK <br />��,r �W�enO <br />" 1 <br />WORK DESCRIPTION .-- � V �!� <br />J-N`� G/Zic2 � GNAN i S��{x7GM�l�JT <br />�7u.�-ry �Ek1 �sv?Lni�C Corzc- !-�^�'� `��L��L- <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BathWb <br />La��atory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dislnvasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Back(iow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />Mtl:F1ANIl:AL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C-airhan lingunils <br />Forced air stems <br />Gas pipin <br />Waler h ter <br />Gas fir lace <br />Gas r nge <br />R ge liood <br />haust fan <br />eal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERET7 ;.00AL SALES 7AX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know lhe same to be irue and correcl. All provisions of laws and <br />ordinances governing Ihis type o( work will be complied with whe!her speci6ed herein or noL The yranting of a permit does nol presume <br />to give aulhonty to violale or cancel the provision of any other stale or local law regulating construction or the performance of <br />constmction. That �I �� �rized by Ihe owner of Ihis property to perform lhe work for which application is made and I comply wilh lhe <br />Stat�o a rs(Law 18. 7�RCW and 2$[.200 WAC. �— <br />� C�+-�'L� �FL� ���'� �3I � 3 r U <br />Signalure of Own ctor/Aulhonzed Agenl �Date <br />I/ <br />z <br />0 <br />
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