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05/07/2014 IV'ED 16:40 FAX 425 379 7045 WA Natural Gas 0 002/003 <br />9 0 <br />PERMIT APPLICATION <br />BUILD, ING/MECHANICALIPLUMBING/SIGNISPRINKLERIDEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425.257-8810 FAX 425-257-8857 www.evere .orq <br />A DDr IMATV1OD ADC Ar PCDTCn V0111A RAM Tr1 A PIA S _ I <br />SITE ADDRESS: 3512 LOMBARD AVE <br />`ROPER Sg a u0 <br />PERrdl 6 13 <br />LEGAL for newconstruction: Shon Plat/subdsvlslon Loi No._ (attach oopyof long legal description) <br />OWNER JOHN DAVID 8r DEBORAH BELEW <br />PhonetEtna9208-874-8058 <br />Addres.,3512 LOMBARD AVE <br />CiWState1ZpEVERETI WA 98201 <br />APPLICANT:_ Owner _Owner's Agent AContractor _CordraelofSAgcnf _Tenant(n pmvup pronerprmnsenr wmmee..,anmwnmu1e/c-wu) <br />CONTRACTOR W ASHINGTON NATURAL GAS HEATING & A/C IL 81 Lie. # <br />111 3LD COE Bus. Lie. # OiKo <br />Address2615 W CASINO RD STE # 213 phonetEmad425-347-1414 <br />TENANT BUSINESS NAME <br />CONTACT FOR PERMIT <br />WASHINGTON NATURAL GAS 425-347.1414 <br />phonoli-mail <br />BUILDING PERMIT APPLICATION <br />ICONTRACT PRICE OF WORK, <br />Existing Use of Building HEAT SOURCE: <br />Proposed Use of Building GAST Electric Other _-_ <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi -Family _ Commercial <br />Type of pro ect New Addition Romadel Repalr _ T.I. _ Sion _Sprinkler _ Demollllon Change of Use <br />DESCRIPTION OF WORK (adddtonaf:par, provided on the back): <br />Ow r( 1 %V�o Y) CLk-t�S e, a <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Projucl: _Now ___Addn AltnatlCfi_Repair <br />Show Number(/!) ai VP�ms <br />Typool Project: _Now_Addn _Alteration_Repair <br />Show Number i of fixtures _ <br />AtC — air handling units <br />Toilet <br />Forced airs stems <br />Bathtub <br />Gas piping <br />Lavaloiwash basin _ <br />Water heater <br />Shower <br />Gas fireplace <br />Kitchen sink 8 disposal _ <br />Gas range <br />Dishwasher <br />Clothes dryer <br />Clothes washer <br />Range hood <br />Water heater <br />Exhaust fan <br />Sink sarvicetbar/mo lelc.) <br />Heal pump <br />Backffow preventer <br />Unit heater <br />Urinal <br />Bolter <br />Drinking Fountain <br />Refri elation <br />Floor drain <br />Woodsb)ve <br />Grease try <br />Dueling <br />Roof drains <br />Other <br />Medical Gas <br />SPRINKLER / SUPPRESSION SYSTEM <br />Other: <br />Number of Heads <br />Other: <br />I hereby wrbfy that I have read and examined this app'vcotion and know No same to be We and mnect. All provisions of taws and prdlnanpea governing this type of work wo be comp'ied <br />with"ether specified herein or nol. The g,ongng of a penny does "I presume to give oulharly to violato or cancel the provision of any other state or?opal law leguybng COSINegon <br />That I ears lhodsed by the owner of this property to perform the work for which application is made and 1 comply wah the slate Contractors Law 10.27 RCW and 296200A WAC. <br />(Rsvised 62012) <br />