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SEPA 06-037 <br /> � PERMIT ,�PPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 —FAX 425-257-885�—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 10001 13th Ave. SE, Ever=_tt, 98208 (.,� 1����'C`'� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 4e <br /> OWN[R ADDRESS CITYIZIP PHONE � <br /> Greenfield Park LLC 9514 4th SL NE Suite#102 Lake Slevens, 98258 425-953-7470 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Britlney Lundberg 425-953-1470 x 123 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> Greenfield Park LLC 9514 4lh St. NE Suite#102 Lake Slevens, 90258 425-953-1470 <br /> CONTR.UCENSE# GREENPL942Q2 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Single Family Home _Electric X Gas_Olher <br /> WORK DESCRIPTION <br /> Basic#302-2 Car <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM N0. NPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C—air handling units <br /> 2 Bathtub 1 Forced air systems <br /> 4 Lavatory(wash basin) � Gas piping <br /> 1 Shower 1 Water heater <br /> 1 Kiichen sink&disposal 1 Gas fireplace <br /> 1 Dishwasher I Gas range <br /> 1 Clothes v:asher 1 Clolhes dryer I <br /> Laundry iray i Range hood <br /> Sink(servicelbadmop/eta) (0 4 Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> i _ Floor drain = Refc, eratior. <br /> Grease trep W000stove <br /> 1 Roof dreins Other <br /> Olher <br /> qN OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceriti�y that I have read and examined this application and know ihe same to be true and correct. All provisions of laws and I I <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> Ito give authority to violate cr cancel the provision of any other state o�local law requlating construction or the performance o( <br /> construction. That I am authorized by the owner of this property ro perform the work for which applicalion is made and I wmply with ihe <br /> Stele Conlractors Law 18 27 RCW and 296200 WAC. ', <br /> � /. ��/ j% � —, '� <br /> � i' li� � i i(,t;� � �i_j��L�/ .r �l'/� � ��..���' 7 ��I <br /> SignaWre of Owned ont ctorlAuthorized A9en Da e I/ I <br /> � <br />