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PERMIT APPLICATION <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, NIA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - wwv�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 3 AM TO 4 PM J9�a6 io <br /> SITE ADDRESS PARCEL TAX I.D. p PERMIT p <br /> 1019 Pacific Ave 004375723018U0 �' , � - v��{ <br /> LCGAL LOT NO. BLOCK TNACT OR SUBDIVISION« <br /> oe sc. see attached <br /> OWNER �D�flESS CITY/LIP PMONE <br /> PUGET SOUND KIDNEY CENTER �� 1005 PACIFIC AVE---EVERETT,WA 98201 <br /> 1ENANT NAME CONTACT FOR PGRMIT PHONE 425-776-8835 <br /> Puget Sound Kidney Tracie Skiles newpermitspberryneonsigns.mm <br /> E-MAIL <br /> C N R CTOR AUUNESS UIY21P PN N� <br /> BERRY NEON SIGN SYSTEMS 7400 Hardeson Rd, Everett,WA 98203 425-776-8835 <br /> CONTR.LICENSE N BERRRYNC077CM <br /> USE OF BUILDING HEAT SOURCE CONTRAC? PRICE OF WORK <br /> COMMERICAL I ___Electric ___ Gas ___Other $2390.00 <br /> WORK DESCRIPTION <br /> INSTALL 1 non-lit wall sign <br /> PLUMBING MECHANICAL <br /> NO. �YPE OP (IXTUR[ Ofl I7CM N0. TYP[ OF H%TUNE OR ITCM <br /> Toilet __ A/C - air�:andling units <br /> Bathtub __ Forced air systems <br /> __ Lavatory(wash basin) ____ Cas piping <br /> Shower __ Waterheater <br /> __ Kitchen sink& disposal ____ C,as fireplace <br /> Dishwasher ___ Gas range <br /> Clodies washer ___ Clotlies dryer <br /> Water heater ___ Range hood <br /> ___ Sink(serviceiUar/mop/etc.) ____ [xhaustian <br /> ___ Rackflow p�eventer ____ Heat pump <br /> Urinal ___ Unit heater <br /> __ Drinkiny Fountain ____ Boiler <br /> Floordrain ___ Retrigeration <br /> ___ Grease irap ____ Woodstove <br /> Roofdrains ____ Other__________________ <br /> -- Other------------ --- ----------------- <br /> UTY Of [VCRC77 LOCAL SALES iAX COOE IS 3105 <br /> I hereby cciinfy that I have read and examined this application and know ihe same ro be true and correct All provisions of laws and <br /> ordinaces yoveming this rype of work will be complied with whether specified herein or not 7he grantlng of a permit does not presume <br /> to give authoriry ro violate or cancel the provision of any other state or bcal law regula6ng conshucdon or the periormance ot <br /> constnution. T hat I am authorized by the owner of tliis property to perform the work for which applicaUon is made and� comply wiih the <br /> ;�ate it•actors Law 18.27 and 29G.200 WAC. <br /> ca <br /> Si at uf wnedContractodAuthorizedAgent Date <br /> IZ <br />