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PL.�MIT APPLICATIG. � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��`��'roy <br /> 425-257-8810 — FAX 425-257-8857 <br /> � /D D�_ <br /> SITE ADDRESS PA�ICEL TAX I.D. q PERMiT x <br /> 5705 Evergreen 'day 00393200201301 SCPA04-043 <br /> LEGAL LOT N0. BLOCK TRAC7 <br /> uesc. lg Z 6everly Hills Division No. 4 <br /> OWNER ADDRESS ZIP PHONE <br /> ;ienry �4. Gilmore 5705 Evergreen !lay, Everett 98203 (425) 355-8355 <br /> TENANTNAME CONTACTNAME PHONE <br /> Charles K. Coad I Charles Y.. Coad (360) 568-3226 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> Meyer Sign and Advertising Co. , Inc. 2608 Highway 99, 61t. Vernon 98273 CCO1 t4EYERSA038QE <br /> PHONE <br /> PROPOSED USE OF BUII.DING BUilding Mechanical Ad�ilion HEAT SOURCE <br /> PERMIT R Combinalion � Plumbing WORK R Aiteraiion D Electric <br /> Freestanding 3illboard TYPE D Dernolition Sign rvFe D New �a D c�s <br /> Sign Structure U Sprinkler U Fep.,irlMaint. U Olher <br /> CONTRACT PRICE OF WOpK /fD��l/1 —� CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> / /(/ <br /> WORK DESCRIPTION <br /> Installation of a monopole, double-faced 10' � 20' sign structure <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE QR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATIiTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS I <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATER HEATER <br /> CLOTHES N�ASHER _ METAL FIREPLACE/STOVE ' <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPL4CE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTI�ER _ OTHER <br /> I HEHEBY CEFITIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAM17E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINHCFS GOVERNING THIS NPE OF WORK WILL�E COh1PLIED WITH WIi[THER SPECIFIGD HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CAtJCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOG1L LAW REGULA7ING CONSTRUCTION OR THF PERfORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH OP � ORM THE WONK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT S 18 W JD 6200 WAC. <br /> � 7 <br /> SignaWre ner Contraclor uthorized Agenl a e / <br /> � Z <br />