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Ma r, 8, 2;' 16 2; 47 PM � � N o, 2143 P, 2
<br />P�RMIT APPLICATIO�1
<br />BUlLDING/MECHAN�CAL/PLUMBINC/S1GN1SpR1NKLER/DEMOLfTION
<br />C[TY OF EVERETT PERIVIlT SERV[CES
<br />3200 Cedar St,, Evereft, WA 9t3201 425-257-SS'f 0 FAX 425-257-8857 www.everottwa,org
<br />ADDRESS:
<br />i „�.i. � �
<br />LEGAL tor naw co�isuuctlon� Short Flat�suhdivis
<br />OWNER ,� � lJ ....i.l�° �,�.,
<br />Address ' 6 i` t�,>� � `_�'
<br />� :..F �' '� % ^
<br />ApP�IGANT' _ Owner _ ow�ier's �gent X..._ Contractor
<br />CONTRACTOR G&S HEATING
<br />nadress 340fl EVERETT AVE
<br />�PROPERTY TAX N
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<br />�, r;��1 �'_•{,(,� J,,,.t�.?�.; � C'- 'C��
<br />_.._k.ot No. (attacl� copy o! lon4� ie�lal description)
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<br />f'hone/E-meil i..,� : ,... ;...:(.,�
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<br />CitylSletelZip r `. ;1�'�"�"' tii?'�'�� (�i��, l� `,
<br />CUlltfciC�Of�3AcJC(tt ....__.TP.ft2t1�(mustpruviJnalnlfu�Ufcmtea�tlVnfrllh�nvnnrroao�wrkinthnr.Nscn)
<br />St�te �Ic. � GSHEAC'930RK CHy �us. �ic. # 019685
<br />f'h�ne/Email /�25-252-4402
<br />DAWN WEIM�R 425-252-4402 DAWN@GSH�A�'IN .COM
<br />Pf�urr�iE-inall
<br />BUILDING PERMIT /�PPLICATION CONTRAC7 pRICEOF WORK "'I�.,'� �-t�r;i �_,.�,.
<br />Existin47 Use o( Buildiilg ,, H�AT SOURC[�
<br />F'roposod Use of Buiiding _„_ „__ ��s Eiectric Olher
<br />6uilding fype: ,,,,� Siizgle Family _ DupleX ,_,_,Townlzouse _ Muiti-Farnlly ,,,.,_ Commercial
<br />Type oF proJect: New Additl0tl �omodef Repal� T.I, _ 5ign Sprinkle
<br />DESCiZIPTION OF WORK (aud/llonqi spaae prov;ded on tt�o t�ack) ;
<br />�{�"�
<br />of Use
<br />tUf�CHANICAL P�RMIT APPLICATEON PLUMBING P�RMIT APPLICATION
<br />7y�7e of Project: _Now ��Addn �Alterafion �Ro�IAl� Type of ProjocL• _New _�ddn _AEteraLion ,__Reps��
<br />Sbow NI�lTlbc�' (#} of flztures Show Number �t of fixtu�es
<br />A/C — A(t haridlin units Toilot
<br />? �orced alr s ston,s �atiiiuk�
<br />Gas oio�na Lavatorv (wash basi�l
<br />heatef
<br />Gas range
<br />CloUlos drye
<br />ftanye hoad
<br />�xhai�st fan
<br />HeRt �iUtTl�)
<br />Unit heater
<br />Boiler
<br />i�efriqeration
<br />pucki��
<br />Other
<br />SpRiNKLER / SUPplZESSION SYST�iV1
<br />NurllUor of Heads
<br />Shower
<br />uis3iwasner
<br />Gothes washer
<br />Wat�r heater
<br />Slil{< (sorvicelbar/m
<br />L�Hckflow provoiiter
<br />Urinai
<br />Drinking Fouiatain
<br />FEoor dtaln
<br />Roof drains
<br />MediCal Gas
<br />Oth�r:
<br />Other:
<br />al
<br />i hr.ieby Celllly Ihet I h1VC frFld .�nd r.xen11r1Bd U118 ej�PIICEItIon an�i kn❑w lhe ssma to be truo nnd cvrr<:<:i, �ii prov3slaie otlawa anA orclin:au:�-:: ��,verniny this rype o(work vrifl I�c „�rnpi
<br />wilh ��heiher•padfri� hr.r��in or not. Tha grentinq of a po�rnii dar.s �iol preeume to qivo nulhnrily I�� violyfe orcence! the provision of ,iry ofner etale ar local law rc�ul:ilii�g r.unslructloo
<br />i liat 1 am.auihnri�r:d Ly ihe owner of thla propc�ty io pe�form tne vaork for vdhich ap�dir.yliu�� Is ma¢e end I comDly willilhr. ; lalr. Coritraclors Law 18 27 RCW :mil 298.200A WAC.
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<br />dA�CFioriza�i A�CII[ SlgnAture Dat� ' {FwvISCd 3/21119)
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