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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 www.everettwa.org <br /> SITE ADDRESS: ROPERTY TAX# PERMIT# <br /> P <br /> 1217 Lombard Ave., Everett,WA 98201 00397223900800 <br /> BROADWAY LAND CO S 1 ST ADD BLK 239 D-00-LOTS 8&9 BLK 239 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER STROM CLIFFORD P&SUSAN E Phone/E-mail 425-445-7045/cliff.strom@microsoft.com <br /> Address 4316 212th AVE NE City/State/Zip SAMMAMISH,WA 98074 <br /> APPLICANT:Owner X Owner's Agent Contractor _Contractor's Agent _Tenant(must Provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR PWC CONSTRUCTION State Lic.#PWCCOC"934JP City Bus. Lic.# <br /> 425-754-9917/GEOFF.LI ND@PWCCONSTRUCTION.COM <br /> Address 20250 144TH AVE NE#310,WOODINVILLE, WA Phone/Email <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT Chris A. Hasse <br /> Phone/E-mail (206)550-4618/cahasse@rimkus.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK X11-7 o, — Crr,Gn f <br /> Existing Use of Building Single Family Residence HEAT SOURCE: <br /> Proposed Use of Building Single Family Residence Gas Electric X other <br /> Building type: X Single Family _Duplex_Townhouse _Multi-Family _Commercial <br /> Type of project: New Addition Remodel X Repair T.1. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Repair the damagedstructure to its condition before the fire that damaged it on January 14, 2015. <br /> :vii <br /> � n le/4f� IJ 11 U(J� I'✓ 'G'l <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn _Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C—air handling units Toilet <br /> Forced airs stems Bathtub <br /> Gas piping Lavatory wash basin <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> Heat pump Backflow preventer inside bldg) <br /> Unit heater Urinal <br /> Boiler Drinkin Fountain <br /> Refri eration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owner/Authorized Agent Signature Date (Revised 412015) /� <br />