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� 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 .;EDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425•257-8857—www.everettwa.org <br /> AFPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D,p RMIT j <br /> 524 Pilchuck Path � 010640-000-058•00 � ��.� � ��,3 <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION If <br /> DESC. 58 <br /> OWNER ADDRESS CITV2IP PHONE <br /> Belmonle Heights LlC 9574 4th SL NE Suite k102 Lake Stevens,9d258 425-953-1470 <br /> TENANT NAME I CONTACT FOR PEflMIT PHONE <br /> Brittney Lundberg 425•953•1470 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Belmonte Heights LLC 9574 4th 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#203 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> 3 Toile� A/C-air handling uni�s <br /> 1 Bathtub 1 Forced air syslems <br /> q_ Lavalory(wash basin) 4 Gas piping <br /> 1 Shower ? Water heater <br /> 1 Kitchen sink&disposal 1 Gas fireplace <br /> 1 Dishwasher t Gas range <br /> 1 Clothes washer 1 Clothes dryer <br /> Water heater 1 Fange hood <br /> Sink(scrvicc�badmop/etc.) 4 Exhaust fan <br /> Backllow preventer � _ Heat pump <br /> :/ <br /> Urinal Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain Refrioeration <br /> Grease irap _ Woodstove <br /> Rool drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritily that I have read and examined this application and know the same ta be true and correct. All provisions ol laws and <br /> ordinaces governing Ihis�ype ot work will be complied with whether specilied herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision ol any other stale or local law regulaling construction or the perlormance ol <br /> cons�ruction.That I am authorized by the owner of this property to perform ihe work for which application is made and I comply with the <br /> State C n actors Law 18.27,jiCW and 296.200 WAC. <br /> �� —� -� <br /> fgnaWre ol Owner�� nt ct dAuthonzed Agen� Date �/ <br /> L <br /> � j - <br />