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i/ 1.3/11 09 : 5£3PM PD'1' ' 8666104F � ' —> 14252578II57 p� ��3 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 -425-257-8810—FAX 425-257-8857—vnvw.evere�v(.`G �`)U r <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� Vl <br /> S'TEA°°RESS: 2323 Lombard Ave PRf������49401200 PE T� <br /> LEGAL far nmv tensimtlian' Shctl PlaVsubdivision Lot No._ (altach ccpy of long Iegai desaiption) <br /> OWNER Micke Pave Phone/F-mail <br /> Ad�«ss 2323 om ar Ave City/5tateTip Everett WA <br /> CONTRACTOR Belfor USA Grou ��i �ic.i� BELFOUG990BJ <br /> sddress 4320 S 131St PI, Ste 100 Seattle 981G8 Phcne/Email 206-321-6559 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Phone/E-mail curt.knutsen@us.belfor.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK $7500.00 <br /> Existing Use of 8uildina Residence HEAT SOURCE: <br /> Proposed Use of Building cas_ Electdc X otner_ <br /> Buiidingtype: �SingleFamily _Duplex_Townhouse _Multi-Family _Commercial <br /> Typeofproject�. _New _Addition _Remodel X Repair_T.L_Sign_Sprinhler_Demolition_Change ofUse <br /> Descflption of Wofk(addRional space provided on the Wck): <br /> Repair or replace as required damaged framing, roofing, siding, drytvall from fire. Affected areas <br /> laundry room, kitchen and d�ck. Repairs/Replacement �vith like kind and quality compliant materials <br /> Havcyous�an�dwarkinywitnomaP��mic� _ves _No Opened forfire and electrical investigation/inspection <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Typo of PfojocL• _Naw_Addn _P.Itnntion_Ropair Typo of PrajocL• _Norr_Addn _Altoration_Ropair <br /> Show Numher(i9 oI fiztures Show Num6er(:9 oI fi.rtures <br /> ! A/C—air handling uni[s I Toilet <br /> i Forced alr systems i Bath[ub <br /> Gas i ino i Lavator wash hasin) <br /> I Water heater I Shower <br /> � Gas tireplace ! Kitchen sink 8 disposal <br /> � Gasran�c I Dishwasher <br /> � Clo[hes dryer � Clothes washer <br /> "�—� � Range hood I Water heater <br /> I I Exhaust fan j Sink(service/badmo /etc.1 <br /> i � Heat pump I Backflo�.v preventer <br /> ' � Unit heater i Urinal <br /> I i Boiler i Drinkin Fountain <br /> 4 � Refrigeration ; Floor drain <br /> j Woodstove � Grease trap <br /> � Ductinn Roof drains <br /> � Other I Medical Gas <br /> SPRINKLER 1 SUPPRESSION SYSTEM i Other: <br /> i <br /> I NumberofHeatls i Other. <br /> I herehy certity thal I have read and ex�minetl this application antl know Ihe same to he Irue and correcL All piovi,ions of laws and ordinances goveming <br /> this lype of work v,ill be complied��ith wfiether spedfied herein or not.The granling of a permit does not presume lo give authority to violate or cancel <br /> thr.ryro�ision of any other state or local lam ragulating consimclion or the peAormance of construction.That I am authorized by Ihe o�.:ner of thi;propeey <br /> �o petinrm thr worY.for clL:.e cation�is-made and I comply c:ith the State CoNractors La�v 7827 RCW and 296200 WAC <br /> ��% <br /> ����� 9/13/11 <br /> Ow/N7{uth6rizedAr�ent Signmurc Date �ReviscrJ?l'J71) <br /> . i <br />