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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 otg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # I # <br />,PERMIT <br />'' S 1 121h St SE 401800 1� 7l- <br />LEGAL LOT NO. BLOCK r TRACT <br />DESC <br />OWNER ADDRESS CITYIZIP PHONE <br />Silver Lake Ventures ING — — <br />TENANT NAME <br />76 Cas Station <br />CONTACT FOR PERMIT PHONE <br />Steven Thomson 425-917-2109 <br />CONTRACTOR insignia Sign Inc. ADDRESS CITYIZIP PHONE <br />PO BOX 2849 Renton, WA 425-917-2109 <br />CONTR. LICENSE # INSIGS1062OZ <br />USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br />76 Gas Station_ I _Electric __ Gas _Other $3000.00 <br />WORK DESCRIPTION <br />Remove existing 76 signage and replace with new Oasis image 76 signage. All <br />Hooked to existing electrical sign circuits. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURF OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units <br />_ <br />Bathtub <br />Forced ail systems <br />Lavatory (wash basin) <br />_ <br />_ <br />Gas piping <br />Shower <br />Water heater <br />_ <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Dishwasher <br />__ <br />Gas range <br />_ <br />Clothes washerClothes <br />dryer <br />Larindry tray <br />_ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc <br />_ <br />Exhaust fan <br />_ <br />Backfiow preventer <br />— <br />Heat pump <br />Urina I <br />--Unit <br />heater <br />Drinki ng Fountain <br />_ <br />Boiler <br />_ <br />Floor drain <br />_ <br />Refrigeration <br />_ <br />Grease trap <br />— <br />Woodstove <br />_ <br />_ <br />Roof drains <br />Other <br />- <br />Other <br />— <br />I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work, will be complied with whether specified herein or not. The granting of a permit dccc not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance or <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />Steven 560111,1011 Agent) 7/ 25 /07 <br />Signalure oOwner/Contractor/Authorized gent Date I/- <br />