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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 NRE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.O.# P�R�MJR!/ <br /> 530 Pilchuck Path 010640-000-061•00 � /OS �U <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. g� <br /> OWNER ADDRESS CITY2IP PHONE <br /> Belmonte Heights LLC 9514 4th St. NE Suite#102 Lake Stevens,98258 425•953•1470 <br /> TENANiNAME I CONTACTFORPERMIT PHONE <br /> Brittney Lundberg 425•953-1470 <br /> CONTRACTOR ADDRESS 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 /> I — <br /> Electric X Gas_Other <br /> WORK DESCRIPTION <br /> Basic#204 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF Fl%TURE OR ITEM NO. TVPE OF FlXTURE OR ITEM <br /> 3 Toilel A/C-air handling units <br /> 2 Bathtub 1 Forced air systems <br /> _g_ Lavalory(wash basin) 4 Gas piping <br /> 1 Shower 1 Water heater <br /> 1 Kitchen sink&disposal 1 Gas firepiace <br /> 7 Dishwasher t Gasrange <br /> 1 Clothes washer 1 Clo�hes dryer <br /> Water heater 1 Range hood <br /> Sink(scrvicc�badmoplelc.) 5 Exhausl fan <br /> Backllow preventer _ Heat pump <br /> Urinat Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain Relrigeration <br /> Grease lrap _ Woodstove <br /> Rool drains Other <br /> Other <br /> Clri OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilily that I have read and examined this appiication and know the same to be true and correct. All provisions ol laws and <br /> ordinaces governing�his type o(work will be complied with whelher specilied herein or not.The granting of a permit does not presume <br /> to givo authority to violate or cancel the provision of any other state or local law reguiating construction or the peAormance of <br /> construction.That I am authorized by lhe owner of ihis property to perform the work lor which applica�ion is made and I comply with the <br /> SWIe Con ractors Law 1827 flCW and 296.200 WAC. <br /> _ — � <br /> ignature ol Owner/ ont2c or/Authonzed Ag Oate �/ <br /> L Z <br />