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To: E Page 2 of 4 2016-04-12 06:03:32 (GMT) 18884000383 From: Deborah Shields <br /> 0 0 <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:5713 BEVERLY LN PROPERTY TAX#004717000014 504 PERMIT# <br /> LEGAL for new construction: Short Plat subdivision Lot No. (attach copy of long legal description) <br /> OWNER HENRY PO Phoneiln-mai1206-779-7785 <br /> Address5713 BEVERLY LN City/StatezipEVERETT, WA 98203 <br /> APPLICANT:_Owner _Owner's Agent _ContractorIV <br /> / Contractor's Agent —Tenant(must provide a letterof consent frons the owner w do work in the space) <br /> CONTRACTOR Washington Energy Svcs Co, LLC state Lic.#WASHIES851 NS City Bus. Lic.# 054773 <br /> Address3909 196th St SW, Lynnwood, WA 98036 Phone/Email800-398-4663 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Jennifer Covello/Jennifer@nwpermit.com 206-774-9499 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK .5?R4 00 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gasw] Electric Other <br /> Building type: Wkingle Family Duple LJTownhouseL <br /> -Family Commercial <br /> Type of project: New Addition Remodel Re air T.I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> ELEC TO GAS FURNACE REPLACEMENT <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project Ne ddn Z/ Iteration_Repair Type of Project�Ne ddr 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 pumpBackflow preventer <br /> Unit heater Urinal <br /> Boiler <br /> Drinking Fountain <br /> Refrigeration Floor drain <br /> i Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM other: <br /> Number of Heads i 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 al r sir. d h!dAiofthis�fog,?rtKto r(o Iy �,.pl,r f,,��lhaor�Cfor which applicator is made and I comply with the State Contractors Law 18.27 RCW and 2962o0A NJAC. <br /> 04/11/2016 <br /> Dales 2016.04.1.1123:01.51 6T6U <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />