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�' I <br /> � . <br /> � SEPA 06-03� <br /> PERMIT APPLICATION <br /> GIl'Y OF �VERETT PERMIT StRVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 42E�-257-8f31 C — FAX 425-257-8857 —www.everettwa.org <br /> APPLICAT'IONS ARE ACCEPTED FROM 8 AN TO d PM <br />'� SITE ADDRESS PARCEL TAX I.D.# PERMIT 8 <br /> 10016131hDr. 5E, EverelL 98208 L(��7QG( -C� . <br /> LEGAL LOTNO. BLOCK TRACT � <br />; � nesc. I ! <br /> 3E <br /> OWNER AODRESS CITY2IP PHONE j <br /> Greenfield Park LlC 9514 4Ih Sl. NE Suite#102 Lake Stevens, 98258 425-953-1470 � <br /> I <br /> i TENANT NAME CONTACT FOR PERMIT PHONE � <br /> Britlney Lundberg 425-953-1470+c 123 li <br /> CONTRACTOR ADDRESS CITY/7.IP PHONE <br /> � Green(ield Park LLC 9514 41h SL NE Suite#102 Lake Slevens. 98258 425-953-1470 <br /> j cON7R.LicENSEtt GREENPL942Q2 �, <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> Singte Family Home _Eledric X Gas_Olher <br /> WORK DESCRIPTION I <br /> Basic#302-2 Car <br /> I PLUMBING MECHANICAL <br /> INO. TVPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM i <br /> I 3 Toilet _ NC-air handling units � <br /> , 2 Bathtub 1 Forced air systems i <br /> 4 Lavarory(wash basin) 3 Gas pipir3 i <br /> II 1 Shower 1 Water heater I <br /> 1 Kitchen sink&disposal 1 Gas fireplace I, <br /> 1 Dishwasher Gas r nge i <br /> 1 Clothes washer 1 Cbthes dryer I <br /> _ Laundry tray 1 Range hood <br /> Sink(service/bar/mop/etc.) 5 Exhaust fan � <br /> _ Backflow preventer _ Heat pump I <br /> Urinal Unit heater <br /> Drinking Fountain Boiier <br /> Floor drain Refrigeration <br /> Grease hap Woodstove '�, <br /> 1 Roof dreins _ Other � <br /> I _ Other — I <br /> CITY OF EVcRETT LOCAL SALES TAX CODE IS J105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> �. ordmaces goveming this type of work will be complied with whether specifed herein or nol. The granting of a permit does not presume <br /> to give authorily to violate or cancel the provision of any other state or local law regulating construction or ihe performance of <br /> � construction. Thal I am a�ihorized by ihe owner of this property to pertortn the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> (' �_- <br /> n <br /> � � ��/ ��� .-�;� � / J�' .��� � � � -- � <br /> Signalure of OwnedCo/�lt ctor/Au�horized Agent -" D te � (I� <br /> � ` ----- I <br />