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PkRMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 -FAX 425-257-8857-www.everethnra.org <br /> APPLICATIONS ARE ACCF.PTED FROM 8 AM TO 4 PM 1 3 � ] <br /> I y <br /> SITE ADDRESS //C 3 7- �U����''�'i PARCEL TAX I.D.iM P RMIT# <br /> WC�\ ' • �tG/'t•�.� ; Lli}� � 1c � �.P�.� - 3 � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. S <br /> OWNER ADDRESS r CITY2IP PHONE <br /> 1'►`F <br /> LrUe� v�,, lC�. 4'�S S <br /> TENANT NAM S���yS �Teyyaki) CONTACT FOR PERMIT <br /> f1�'�7a.� �vo� ' �//�-r, Le � 3�6:38�-338� <br /> CONTRACTOR LE��S L(A,CK� �DRESS^ C1ITY2IP �'1� <br /> �(�'��..5_ .��� �(f L fl S� (.�0�� ..�i��J <br /> CONTR.LICENSE# t��S`E �� V D�� � <br /> � /� � '�/% �uc� w,b S6'vor� �- 3,3 6a <br /> USE OF BUILDING ���� HEAT SOURCE I CONTRACT PRICE OF WORK <br /> R�s',,{a��—�i� � I _Electric _Gas_Other �� ��� <br /> , <br /> WORK DESCRIPTION <br /> �' S�z�.c,t..1U�Z. 1—� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> i � <br /> Toilet •AIC=air haodling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Ki!chen sink&disposai _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exheustfan <br /> Backflow preventer _ Healpuiip <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be We and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or not.The granling of a pertnit does not presume <br /> to give authority to violale or cancel lhe provision of any other state or local law regulatlng construc6on or the performance of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br /> State Contractors , 1,8�� RCW�gd 296.200 WAC. <br /> , , G- �`'�__ �- ��- -��-�6 <br /> Signature of nedCoMractod orized gent Date (/ <br /> Z <br />