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( <br /> PERMIT APPLICQTION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 10005 13th Ave. SE, Everett, 98208 28051900102500 �'� �]j7 �J <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. qs <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Greenfield Park LLC 9514 4th St. NE Suite#102 Lake Stevens, 98258 425-953-1470 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Brittney Lurdberg 425-953-1470 x 123 <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> Greenfield Park LLC 9514 4th SL NE Suite#702 Lake Stevens, 98258 425-953-1470 <br /> CONTR.LICENSE# GREENPL942Q2 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Single Family Home Electric X Gas_Other <br /> WORK DESCRIPTION <br /> New Home Basic#302-2 Car <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub � Forced air systems <br /> Lavatory(wash basin) .i� Gas piping <br /> I Shower I Water heater <br /> I Kitchen sink 8 disposal I Gas freplace <br /> � Dishwasher � Gas range <br /> � Clothes washer 1 Clolhes dryer <br /> Laundry lray � Range hood <br /> Sink(service/bar/mop/etcJ �_ Exhaust fan <br /> BackAow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> y Roofdrains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know the 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 noL The granting of a permii does not presume <br /> lo give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> St�te G.ontractors Law 1827 RCW and 296200 WAC <br /> I,�l �,�� i 1� I31IO � <br /> ignature of OwnedC n ractodAuthonzed Agent � D te �/2 <br />