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To: E Page 6 of 8 2015-08-18 15:15:56 (GMT) 18884000383 From: Deborah Shields <br />• <br />• <br />��� �T ��������'�� <br />�E1tL�iNE�ft1�ECHAN�CA�IPi.U11�IBINC�ISiGN15F��.[�1KLERfC��iVRtiLiTlt�� <br />CiTY OF EVERETT PERtVI1T SERVECES <br />3200 Cedar St., Euerett, VI�A y8201 425-257-88i0 �AX 425-257-8857 ww�w.everettwa.org <br />I/�/1 I �/l�, ..r �:2.� <br />A°°R�Ss: 4928 W I LLM I N GT� N AVE IPROP��rv r'�x # 00410200006400 I uCs�R�ET � <br />LEGRI_ iar hev✓consfruction: �hait PlaUsuCdivision !„ut Na. ;ait�ch copy of lany I�g�l r,iescrlptichj <br />oyyNERSTEVEN VAN ANTWERP �r�cnE��_��a;�425-343-5500 <br />�aa��ess4928 WILLMINGTON AVE ;;ny�state�z.;�EVERETT, WA 98203 <br />AF'PLIGANT: _ ONrter _ O,^n��r's /�gent ___. Contra�tor V Contractor'S F�rent � Tenant i�nust Pr3viat. a�i;.� �tco:,s�nirrorn u,� ovmer io ao �A k:�, e�,t sp�ce� <br />CONTRAC70R WESCO statc �ic. # WASHI ES971 �B city �us. �ic. #41349 <br />a.a��z�53909 196th St SW r�,,�,�,N��,rd;,800-398-4663 <br />JCNNIFCF COVCLLO 205-774-9J99 JCNNIFCR(n';NbYPCRh11LCOP.1 <br />f'! ��neJF.-:n�i� <br />I�UILDlNG P�RMiT APP'LiCAT10N GONTRACT PRICE OF WQRkC 6830 <br />Exisfing lJse cii Building Res <br />Pr�posed Use ^f �� ifdin � <br />I3uilding type: �ingfe �amily CJuple ov�n�hause -Family ommerciaf <br />7 e �f ro ect: Nevr Adclition Remodel Re air �.f. Si n S rinkler <br />DESCRfPTIQN OF WORK (additional space p�ovided on the back) : <br />REPLACE HEAT PUMP (same location} LOCATION: SOUTH SIDEWALL WHERE CURRENT H/P IS <br />MECHAWlCQt PERMIT A�PLICATt(1N <br />iy�N nf Prujecr. _ New �Addn l v Alteration _Repair <br />Show Number {#) of fixinres <br />---._ � <br />i /�/C — �ir h<3RCIIIPIq Ul1rfS <br />i Fcarced air syst�ms <br />Gas pining <br />Water heater <br />Gas fireplace <br />Gas range <br />Ciothes dr�rer <br />Range hood <br />Exhaust fan <br />' ' Heat purrt� <br />r <br />Unii heater <br />�oiier <br />�IVoodsto�ie <br />Other <br />PRINKLER / SUPPE2ESSION SYSTEM <br />? Nurnber c�f Heads <br />hI�AT �OIiRCE: <br />O [h er <br />Ct?an�e af Use <br />PLUMBlN�a PERIV(IT APPL{GATiON <br />�f Praject: �New_,,,_Adc�i��,lteratir <br />Show Numher (#) of fixtures <br />'��1�2i <br />i Bathiub <br />Lavatory (v✓�ash bas <br />� Sliower <br />Kitchen sink & disp� <br />Dishw�,sher <br />���( Cloihes wasl�er � <br />V�Jater heater <br />Sir�k (serviceibarim <br />E3ackffow preventer <br />U rinal <br />Urinking Fourttain <br />-� Floor orain <br />Grease tr� <br />i <br />RooF drains <br />Medicaf Gaa <br />' Other: <br />Jther: <br />_Repdir <br />1 t�ereby certify ih�t I have read and exr.rnfnec! this appiiraho�; ar,d knnw Ihe sams to be true and correct FlI1 provisions o` lav:s antl orviinances rav�ming this type cf wark adill be comp <br />•.vi!h �:�hethc r spe:r,ified harein or not. 1"nn ,yranting ot a permit dnrs not presume to �,ve auther ty to'dinlat� �or cUncal [f�e provision o` any uther s<.ate or lo,^..,�I la�n' rrg�.iiatin� :onstru� tion <br />Tt�iat ( dm authorize�.i by the ewner oT thi6 prupa�ty to peiform tl��a v;oik tur �;ihiich application i5 made atid I camply �vtth the Siate Contractors Lav. 12.2? RCW and '256.2UDA W.4C, <br />Jennifer Covello �� ��. • � ...�.. ,._ ;,<<�5 <br />(7wnerlAuthorized Agent Signature Uate <br />(Revised 9,'2014) <br />