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I <br /> . � � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �QS'O4Z <br /> SITE ADDRESS i f PARCEL TAX I.D.N PERMIT If <br /> 508PilchuckPath `6�11/ � 010640•000•O50•00 Q �? <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION• <br /> DESC. 50 <br /> OWNER ADDRESS CITY2IP PHONE <br /> Belmonte Heights LLC 9514 4th St. NE Suite#102 Lake Stevens,98258 425-953-1470 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> Brittney Lundberg 425-953-1470 x123 <br /> CONTRACTOR ADDHESS CITY2IP PHONE <br /> Belmonte Heights LLC 9514 4th St. NE Suite#102 Lake Stevens,98258 425•953-1470 <br /> CONTR.LICENSE# <br /> BELMOHL94480 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric X Gas_Other <br /> WORK OESCRIPTION <br /> Basic#204 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> � Toilet NC–air handiing units <br /> 2 Balhtub 1 Forced air sys�ems <br /> � Lavatory(wash basin) 4 Gas piping <br /> 1 Shower ? Water heater <br /> 1 Kitchen sink 8 disposal 1 Gas Iirepiace <br /> 1 Dishwasher 1 Gas range <br /> 1 Clothes washer 1 Clothes dryer <br /> Waler heater 1 Range hood <br /> Sink(service'bar/mop/etc.) 5 Exhaust lan <br /> Backllow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Foun�ain _ Boiler <br /> F�oor drain Relrigeration <br /> Grease Irap Woodstove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corre:l. All provisions ol laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit dces not presume <br /> to give aulhority to violalo or cancel ihe provision ol any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by Ihe owner of lhis property to perform Ihe work for which application is made and I com�ly with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �, !"K �/_� � <br /> Sgnature ol OwnedConiractor/Authorized Agent Date <br /> f'� <br /> �I� ) <br />