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SEPA 06-037 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wvn,v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> 10021 13th Ave. SE, Everett, 98208 2805790010250 �'�'O�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. q� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Greenfeld Park LLC 9514 4th SL NE Suite#102 Lake Stevens, 98258 425-953-1470 <br /> TENANTNAME I CONTACi FORPERMIT PHONE <br /> Brittney Lundberg 425-953-1470 x 123 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> Greenfield Park LLC 9514 4th SL NE Suile#102 Lake Stevens, 98258 425-953-1470 <br /> CONTR.LICENSE# GREENPL94242 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Single Family Home Electric X Gas Other <br /> i — — — <br /> WORK DESCRIPTION <br /> Basic#302-2 Car Garage <br /> PLUMSING MEC.4ANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C–air handling units <br /> 2 BathWb 1 Forced air systems <br /> 4 Lavatory(wash basin) 3 Gas piping <br /> 1 Shower � Water heater <br /> 1 Kitchen sink&disposal 1 Gas fireplace <br /> 1 Dishwasher Gasrange <br /> 1 Clothes washer 1 Glothes dryer <br /> Laundry iray 1 Range hood <br /> Sink(service/bar/mop/etc.) 6 Exhaust fan <br /> BackFlow preventer Heat pump <br />� Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrep Woodstove <br /> 1 Roof drains Other <br /> Other <br /> CIN OF EVERETT LOC"!.SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this appiicatwn and koow the same to be true and currect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the proaision of any other stdte or local law regulating construction or the performance of <br /> construction.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with the <br /> fale Contra tors Law 1827 RCW a d 296200 W,(�,C. <br /> i ,�; � <br /> , �� �',��l`�{�l� /'1( l' � l�i��1 �J �� ��� <br /> rgnature of Owner ConUactpr/Auth ¢ad AgBnt ; � Date � <br /> (. i ` �Z <br />