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To: E Page 5 of 6 1\ 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 I 1A,4 W15 <br /> PROPERTY TAX#00596200301100 PERMIT# <br /> LEGAL for new construction: Short PlaYsubdivision Lot No. (attach copy of long legal description) <br /> OWNER ROGER DARLING Phone/E-mail <br /> Address4020 GRAND AVE City/State/LipEVERETT 98201 <br /> APPLICANT;—owner _Owner's Agent _Contractor Y Contractor's Agent Tenant(must provide a letter of consent from the cmwr to do work in the space) <br /> CONTRACTOR Washington Energy Svcs Co, LLC state Lic. # WASHI ES851 NS City Bus. Lic.# 054773 <br /> Address 3909 196th St SW, Lynnwood, WA 98036 1 Phone/Email 800-398-4663 <br /> TENANT BUSINESS NAME CONTACT FOR PERMIT <br /> Jennifer Covello/Jennifer@nwpermit.Cam 206-774-9499 <br /> Phone/E-mail <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK 3864 00 <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gast Y 110 1 Electric I Other <br /> Building type: Dingle Family LDuplex ownhouse Family Comrrlercial <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 /> GAS TO GAS TANKLESS WATER HEATER INSTALL <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project Ne ddn 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 pipingLavatory wash basin <br /> Water heater i Shower <br /> Gas fireplace Kitchen sink&disposal <br /> I Gas range Dishwasher <br /> I Clothes dryer Clothes washer <br /> Range hood Water heater <br /> ! Exhaust fan Sink Iservice/bar/mo /etc. <br /> Heat pumpBackflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting i Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM i <br /> 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 grantng of a permit does not presume to give authority to violate or cancel the provision of any other state or local haw 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 /> ter Covello <br /> Jennifer Cove��O Date:120Csign5 Gb o6.28yJennI <br /> 1 c 2E-07' 00' 08/03/2018 <br /> Owner/Authorized Agent Signature Date (Revised 3/2014) <br />