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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> ���)�'� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���� DR n PARCEL TAX I.D.# PERMIT# <br /> e�a���-s�Eve elt, 98208 28051900102500 �' ,� ]/Z " � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS CIN/ZIF PHONE <br /> Greenfield Park LLC 9514 4th 5L NE Suite�102 Lake Stevens, 98258 425-953-1470 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Britlney Lur�dberg 425-953-1470 x 123 <br /> CONTR�CTOR ADDRESS CITYIZIP PfiONE <br /> Greenfeld Park LLC 9514 4th St. NE Suite#102 Lake Stevens, 98258 425-953-1470 <br /> CONTR.LICENSE# GREENPL942�2 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Single Famiiy Home _Electric X Gas_Other <br /> WORK DESCRIPTION <br /> New Home-Basic#300-2 Car <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUhtE OR ITEM <br /> Toilet A/C—air handling units <br /> � Bathtub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> � Shower � Water heater <br /> 1 Kitchen sink 6 disposal � Gas freplace <br /> � Dishwasher I Gas range <br /> �_ Clolhes washer I Clolhes dryer <br /> Laundry tray � Range hood <br /> Sink(service.�bar/mopletc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> � Roof drains _ Other <br /> � Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct All provisions ot laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not The granting oF a permit does not presume <br /> to give 2uthority to violate or cancel lhe provision of any other state or local law regulaling construction or the performance of <br /> conslruction. That I am aulhorized by the cwner ot this property to perform the work for which application is made and 1 comply with the <br /> Sta�te,�ntractors Law 18.27 RCW and 296200 WAC. <br /> r;�r�����r1�l���l�� I��- (�o�- <br /> �Sig ature of Owner/Contr��-r/Authorized Agent Date � <br /> �Z <br />