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, ( � <br /> PERMIT APPLICATIOI� SEPAit06•037 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR0�9 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT/#�-, <br /> 1000312th Dc SE, Everett, 98208 28051900102500 CV l��!'U/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. 60 <br /> OWNER ADDRESS CITY2IP PHONE <br /> Greenfield Park LLC 9514 4th St. NE Suite#102 Lake Stevens, 98258 425-953-1470 <br /> TENANTNAME I CONTACTFORPERMIT PHONE I <br /> Brittney Lundberg 425•953-1470 x 123 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Greenfield Park LLC 9514 4lh St. NE Suite#102 Lake Stevens, 98258 425-953-1470 <br /> cON�R.LIceNSE# GREENPL942Q2 <br /> i <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Single Family Home I _Electric X Gas_Other <br /> WORK DESCRIPTION <br /> 8asic#302-2 Car Garage <br /> PL�VIBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE Of FIXTURE OR ITEM � <br /> 3 Toilel A/C–airhandlingunits <br /> 2 Balhtub 1 Forced air systems ' <br /> 4 Lavatory(wash basin) � .8' Gas piping i <br /> I 1 Shower Water heater <br /> 1 Kitchen sink&disposal 1 Gas fireplace <br /> 1 Dishwasher Gas rarge <br /> 1 Clothes washer 1 C�othes dryar <br /> _ y 1 Ran e hood <br /> _ S nk(erv ce/bar/mop/etc.) � Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain _ Retrigeration <br /> Grease lrap _ Woodslove <br /> 1 Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and wrrect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stale or�ocal law regulating conctruclion or the performance of <br /> construction.That i am authorized by lhe owner of this property to perform the work for which applicalion is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � V'� Z�U� <br /> ignature o OwnedC ractor/Authorized Agent Dale �/� <br /> � <br />