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Owner: A F? 4�i T N C T A V E A NN
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Describe Work . A
Proposed
Legal Descriptitin-.
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TOTALS [."ee
TOTAL . . . . . . . . . . . . . . . . . *0. (40 By L,
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PAYMU;NT!'.]. . . . . . . . . . . . . . . . . �44. 00 K N. A%I
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TOTAL DUE. . . . . . . . . . . . $01 . 00
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�'� Y COMMERCIAL MECHANICAL
�,�` PERMIT APPLICATION
w��t Department of Community Development
City of Arlington•238 N Olympic Ave.•Arlington,WA 98223• Phone(360)403 3431 • FAX(360)403 3447
THIS APPLICATION MUST BE ACCOMPANIED BY FOUR(4)SETS OF CONSTRUCTION DRAWINGS,AND THREE
(3)SETS OF WASHINGTON STATE ENERGY CODE APPLICATIONS.
Type of Permit: ( ) Residential Apartment ( ) Commercial
Project Address: U 3..,/ v Parcel ID#: 31626/I0/ 035C0
Lot#: Subdivision:
Project Description: o
Owner: t` a kQQD ELL7 Phone Number:
Address: 3� C7� City: LY State: Zip Code:
Contact Person:_Kll(ZT -i'AaT1y!6 lz� Phone Number:
Cell Phone: Fax: E-mail:
AwAddress: _.z� City: State: Zip Code:
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Please List Quantity of Fixtures Below:
CLOTHES DRYER FURNACE UP TO 100K BTU GAS OUTLETS
FURNACE OVER 100K FLR FURN INSTALURELOCATE SUSPENDED HTR/UNIT HTR1
APPL VENT/OTHER APPLIANCE REPAIR BOILER UP TO 3 HP
BOILER UP TO 4-15 HP BOLIER UP TO 16-30 HP BOILER UP TO 31-50 HP
BOILER 51 HP AND UP _� AIR AHNDLING UP TO 10K CFM AIRHANDLING OVER 10K CFM
EVAL COOLER VENTILATION FANS OTHER VENTILATION SYSTEM
VENT HOOD DOMESTIC INCINERATOR COM/IND INCINERATOR
ALL OTHER UNITS FREESTANDING STOVE FIREPLACE INSERT
Contractor: t�Oa e"li Phone Number:
Address: Ja-e IVC—• City: ;�r1.�y_1o.' Gtlti . 9� 3
ty State: Zip Code:
Contractor's License Number: C 0,2 Expiration:
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-
described property will be in accordance with the laws,rules and regulation of the State of Washington.
Applicants Signature Date
Print Applicants Name
07 T V�A✓
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FOR STAFF USE ONLY ` "
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Permit# Acce t d By Amount Received Receipt# Date Received
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