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To: Community Development/Permits Page j if 4 2018-04-17 14:12:41 (GMT) 18884000383 From: Northwest Permit Inc. <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 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PET' <br /> r# <br /> 5801 LOMBARD AVE 00495801301100 PrT'**; t. <br /> 0415 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER SARAI LARSON Phone/E-mail 425-737-7166 <br /> Address 5801 LOMBARD AVE City/state/zip Everett WA 98203 <br /> APPLICANT: _Owner _Owner's Agent Contractor 1 contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR SEARS HOME IMPROVEMNT PROD INC State Lic.# SEARSHI011 LA City Bus.Lic.# <br /> Address 1024 FLORIDA CENTRAL PKWY, Longwood FL 32750 Phone/Email 360-9452787 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Naida Khan/Northwest Permit Inc. <br /> t aeg Phone/E-mail 360-945-2787 naidat nwpermit.com <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 10671.37 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric_ Other <br /> Building type; X Single Family _Duplex_Townhouse []Multi-Family _Commercial <br /> Type of project: New Addition Remodel J Repair T.I. Sign Sprinkler_Demolition__Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> Replace 14 squares comp roofing and 2 skylights like for like. No plywood replacement. <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 air systems Bathtub <br /> Gas 'join. Lavatory (wash basin) <br /> Water heater I Shower <br /> Gas fireplace i 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 <br /> I Unit heater ' Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove i Grease trap <br /> Ducting i Roof drains <br /> I Other Medical Gas <br /> SPRINKLER I SUPPRESSION SYSTEM , Other: <br /> Number of Heads j 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 compl <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 WAG. <br /> Nada Khan -:DDigtital2ly0s1g0e4d.1b7y 0N7a1id1a:0K0 ha7 <br /> '00' <br /> Owner/Authorized Agent Signature Date <br /> (Revised 9/2014) <br />