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, <br /> , � � - <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.evorettwa.org � ;/, <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���o� , v <br /> SRE ADDRESS PARCEL TAX I.D.N PERMIT N � � <br /> 520 Pilchuck Path 010640•000-056-00 �%� �7 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> UESG. 56 <br /> OWNB ADDRESS CITV2IP PHONE <br /> Belmon;e Heights LLC 9514 4th St. NE Suite#102 Lake Stevens,98258 425-953-1470 <br /> TENANTNAME I CONTACTFORPERMIT PMONE <br /> Brittney Lundberg 425•953-1470 x123 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Belmonte Heighis LlC 9514 4th St. NE Suite#102 Lake Stevens,98258 425-953-1470 <br /> CONTR.LICENSE K <br /> BELMGHL94480 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric % Gas_Olher <br /> WORK OESCRIPTION <br /> Basic#204 <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FlXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> 3 Toilet NC–airhandlingunils <br /> 2 Bathtub 7 Forcedairsystems <br /> _g_ Lavatory(wash basin) 4 Gas piping <br /> t Shower t Water heater <br /> 1 Kitchen sink 8 disposal 1 Gas fireplace <br /> 1 Dishwasher 1 Gasrange <br /> t Clolhes washer 1 Clothes dryer <br /> Water healer 7 Range hood <br /> Sink(service'barlmop/elc.) 5 Exhaust lan <br /> Backtlow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain Relrigeration <br /> Grease Irap Woodsmve <br /> Rool drains Other <br /> Other _ <br /> CITY OP EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined ihis application and know the same to be true and correct. All provisions ol laws and <br /> ordinaces governing this type of work will be compiied with whether specified herein or not.The granting of a permit dces no�presume <br /> to give authority to violate or cancel ihe provision ol any other state o�local law regulating construction or the perlormance of <br /> construclion.That I am au�horized by the awner of ihis property to perlorm the work for which appiication is made and I comply with the <br /> State Contractors Law 1827 ACW and 296.200 WAC. <br /> � <br /> � ����f� � <br /> SlgnaWre of OwneuContractor/Authonzed Agent Date �/z, <br />