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<br /> ''F4-77' CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> t r a_ � 1� yr
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<br /> ��.. ,,. ,..... 440'444,‘,-,,,i,,,,,,, , ,,,,';-.;%.;;;;-4,,,L;,,,:'*,,
<br /> PROJECT ADDRESS: 1..11 - _ ,,d,/
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) Aa (�% SF 2.9t 1 9—
<br /> BUILDING TYPE: 0 SFR-DETACHED JFR-ATTACHED 0 D PLEX 0 M TI-FA 0tILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: /%t4'i l
<br /> P eie •i ELE r ltio y '
<br /> 7,
<br /> CONTRACT PRICE OF WORK:$
<br /> NUMBER OF DEVICES (if low voltage):
<br /> tt
<br /> FIRE ALARM? 0 YES rl 0
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: (zU t'r /I 'c-c.) /7 OLJ C
<br /> keys
<br /> ONTACT,INIIAATtN
<br /> OWNER NAME: r�/C.� r- an J� TENANT
<br /> T NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: , j/AINSIBUMJ/ (Oh
<br /> CONTRACTOR ADDRESS: STREET
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<br /> CITY 1►t J�mope( STATE V/ ZIP ?,a
<br /> CONTRACTOR PHONE: 6/ $ - 4/q ' 3-6q 7 CONTRACTOR EMAIL: 41(.42i -e t°c I-ve (2 f J (
<br /> CONTRACTOR LIC.#(REQUIRED) `P`I qtAt. 1O`' 0 q CITY OF EVERETT BUSINESS LIC.#(RE% IRED):
<br /> , S4s4/ ...-
<br /> PRIMARY CONTACT: 0 OWNER "CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ? ( ia l CONTACT PHONE: - t/= (IL(- P 7 7
<br /> 4ii'/ ,A/V�fi.l Y� CONTACT EMAIL: ,t/Q'l.( j f rc Ir'c C� ifQ JCv/ .(Gly
<br /> AGREEMEyVT.•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
<br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ' �— I
<br /> � E nod - d38
<br /> A ar/Anfhnri� r1 Anant Sinnatnra data /Ravicarl 0l7.1/9n4R1
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