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MIN PUT APPLICATION <br /> L <br /> BUILDING./MECHANICAL./PLU11AB1NG./SIGN./SPRINKLER./DEMOLITION <br /> E V E R E T Tcinnr OFEV EREITlf PERMIT SERVICES <br /> 32110 CEDAR.STREET.,EVERETT..M(A.98201. <br /> WA SR DntGTON; ((9)405-: ui/-INF11 ) II FAX 41 77- D II(tE))eterattliegisigEweitetttwagm xittttmag 4remitts <br /> '(Blue or Bleck ink Only PJoasej PROJECT SJTE iNFORMATJON <br /> PROJECT SUE a3 ii taff Rte. innrmlc :: y-t.5 t/140110110 0 <br /> EGAi_fenmmavet <br /> ammmaatimmr. ShortPiat/aralndiweiam, L f Mau. (Wes.* yymfi <br /> n amplmn%lecgpiidescrs{ption) a``I. CONTACT IINF+OISIATION <br /> OWNER MIME: inet Wl(Niif Resnisaas RIME( nm : <br /> hOWNER MAILING ADDRESS: srrathEu <br /> ©mw OWE ZIrw <br /> OWNER PHONE: VOWNER EMAIL: <br /> CONTRACION <br /> CONTRACTOR ADDRESS: STREET <br /> COIN STWEE Z1FP <br /> 0•TRACTOR.PHONE:LE: 1 CONTRACTOR EMAIL: <br /> ,$5, ' . ,, ',r""WN ( Ila-::lo): ©111VVOIFI ITT HillUSINIESS WREIIESIE <br /> P1 NIAARY CONTACT: Di CIAMER 01CONTRACTOR Di OTHER ER(QP1 ifr ) <br /> CONTACT NAME DIM/TACTPi ONE: <br /> 1 I CONTACT E Ni9II1L:: <br /> BUILDING INFORMATION <br /> ligiiing} <br /> like �uiititim�: Canenaett Ptriice aff 1W.tradtc:$ <br /> ProposedUse of Building: `Heat Source: ®Gas ®Electric ®Otter <br /> SQIIILDINIG LEE: [DERR 01ra aunthimuas Lalauwil 11JWffAW tnlyy-t#Whitt: .®mmE:1i(6.1311 DA,M1213y attladtlItEe j <br /> hi-we¢f rya r.t Limelw Clieatatneu 031011190ed EaReparir Uir_u_ it:;.,.„, Eiteuoun#i aun (L tole df Use <br /> DESCRIPTION OF WORK: <br /> AM-'i y+-ae-+o (`n& 4 Xi -Ho -or] <br /> ASSOCIATED BUILDING PERMIT*of appttivadle}>: <br /> INECIIIIIMICJIL PERIM APPIJ CATION PININIMINS!®T AFlI JCATIOSi <br /> List of List of list of List otFixtures <br /> Count Count Count Count <br /> AIY,(C—MiitiltecutllirggUllnas (Pilpiini tmw Rxemertter((Meitie;::bag) k r, ,:,,iRAQ,®rConibm <br /> r 4Iker tuttha �lVUmerlhmr ( fP3 ll�) <br /> ��inlfEt�imai�l <br /> Clothes Dryer Heat Pump&Ductless Dishwasher i Sink-Residential(kitchen,bath,bar) <br /> Duct System((Rerrnodel) Refrigeration Drinking Fotsrrainr Sink-Utiddy,,laundry„mop <br /> fatalist Farm( idlentl®Ii)) ClurtmemitailUGsettlldt tIMITT[Daum llicd4tt. <br /> i tba uatt Hill((Type Ii)) IOW Htbstti9PC s tstn)) :a Ihib UMW I <br /> tattaustt iltbabdi((ifoe UN %%terr Netter VAbutifilMistlar FP O%Riga r <br /> lEotIntsueltHffma figsaiflertiial0 Save Yrtate¢r mr-Sand1,elII Otatler SEEITC6iM(Itfinmdlrn )) <br /> Forced Air Systems Other: edical Gas Water Valves or Fixtures <br /> _GetsfFhtmikkodihrreetttilLag 1 [Matins I,-:,. Ifilletter <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Eject/or aSim IPtimP i'• -. <br /> air Su{p{prreHs®m cn his.mf rlrf to <br /> IStapgp»®nS m 'Nm.&llina?. <br /> ACIOYOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this perry*must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> B.ulfdnrg Official Mere Iteskng austrendzed wider airs 61011107761bRIae.n ani Dare=net mrrn as awdfirmnieetas mhe mrurrercif this iimistrady tin arch=the MIMrlir iter wdhrann appifrati"mmis marc. <br /> sief II mum wr;Hh the Mane ranthattes(Law/18327RCN/amtn Utter. <br /> rattyoff fa utftO fmallW (mnly <br /> ,)L (� - b _ l ,� \ 1 \ 0.- 06-)4 <br /> Owner/Authorized Agent Signature Date (Revised 10/10/2018) <br />