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� , <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 /> APPLICATIONS ARE P.CCEPTED FROM 8 AM TO 4 PM �� 7(iJ --¢9 <br /> SITE ADDRESS I PARCEL TAX I.D.p PERMIT li 7 <br /> 510 Pilchuck Palh �,�,'i1 I/ Z- 010640-000•051-00 C�`J �J� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. 5� <br /> OWNER ADDRESS CITY2IP PM <br /> 8elmonte Heights LLC 9514 4th St. NE Suite#102 Lake Stevens,98258 425-953-1470 <br /> TENANTNAME I CONTACTFOHPERMIT PHONE <br /> Brittney Lundberg 425-953-1470 x123 <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> Belmonte Heights LLC 9514 4lh St. NE Suite#102 Lake Stevens,98258 425-953-1470 <br /> CONTR.LICENSE M <br /> BELMOHL944B0 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric X Gas_Other <br /> WORK DESCRIPTION <br /> Basic#204 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF fl%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilcl PJC-airhandlingunits <br /> 2 BathWb 7 Forced air systems <br /> q_ Lavalory(wash basin) 4 Gas piping <br /> 1 Shower 1 Waler healer <br /> 1 Kitchen sink 8 disposal 1 Gas fireplace <br /> t Dishwasher 1 Gasrange <br /> 1 Clothes washer 1 Clothes dryer <br /> Water healer 1 Range hood <br /> Sink(service'bar/mop/elc.) 5 Exhausl lan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Uni!healer <br /> _ Drinking Foun�ain Boiler <br /> Floor drain Relrigeration <br /> Grcase Irap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVEHETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal 1 have read and examined Ihis app�ication and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authority lo violate or cancel lhe provision ol any other state or local law regulating construction or the peAormance ol <br /> construction.That I am auihorized by the owner ol ihis property to perform the work lor whi�h application is made and I compiy with the <br /> Slate Contractors Law 18.27 RCW and 296200 WAC. <br /> �,���,�/.�� � <br /> Si�naWre of Owner/ConVactodAu�horized Agent ' Date 1I <br /> Z <br /> I ' ) <br />