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To: E Page 3 of 6 2016-05-03 13:34:32 (GMT) 18884000383 From: Deborah Shields <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:4020 GRAND AVE PROPERTY TAX a 005962003011001 PERMIT 11 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) / <br /> OWNER ROGER DARLING Phonelln-mail <br /> Address4020 GRAND AVE city/statefzipEVERETT 98201 <br /> APPLICANT: Owner _Owner's Agent _Contractor Contractor's Agent _Tenant imus[provide a letter of consent from the a^marto do work in the space) <br /> CONTRACTOR Washington Energy Svcs CO, LLC IState Lic.#WiASHI ES851 NS City Bus. Lic.# 054773 <br /> Address 3909 198th St SW, Lynnwood, WA 98036 1 Phone/Email800-398-4653 <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 364 no <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas Electric W Other <br /> Building type: Dingle Family Dupla ownhouse -Family Commercial <br /> Type of project: New Addition Remodel Re air T. <br /> I. Sin Sprinkler Demolition Chane of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> REPALCE GAS FURNACE, INSTALL HEAT PUMP <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project Ne 4ddn Iteration_Repair Type of Project Ne>n ddr Alteration_Repair <br /> Show Number # of fixtures Show Number # of fixtures <br /> 1 A/C—air handling units i Toilet <br /> ' Forced airs stems Bathtub <br /> I Gas pipingLavatory wash basin <br /> Water heater i Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> I <br /> Range hood Water heater <br /> Exhaust fan Sink (service/bar/mop/etc.) <br /> 1 i Heat pump Backflow preventer <br /> Unit heater ; Urinal <br /> Boiler i Drinkin Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting i 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 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 /> I0Dlgltallysignedby,lentllterCovello <br /> Jennifer COVei <br /> Date:2016.105.03 0);:28:26-or'00� 05/03/2016 <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />