11131 3RD PL SE 2017-01-13 - Laserfiche WebLink

=��f�� I�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PRA.IECT SITE If+IFORM/�iION PROJECT ADDRESS: l��j � 1^ . � � BUILDING AREA (if residential, new construction, remodel, or addition) R- l� �� SF BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: �i �'L .C�J y--C� �� •� CONTACT INFORMATION OWNER NAME: ,�'jr� �� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREe-r // J I 3 r _�� CITY �(ft� � STA7E � ZIP �� OWNER PHONE: OWNER EMAIL: ._ , _.. _ _ .... _..._ _ _ _ _ _ _ _ _ _ _ __.. .._ _ _. __._ __ . . _... _. CONTRACTOR NAME: V L�, � �� '- � ' � CONTRACTORADDRESS: sTReeT � �� I r1 DC CITY STATE � (J� � ZIP CO TRACTOR PHONE: Q-� I�� CONTRACTOR EMAIL: S7G�l � I�Ct Irr LS C-' �( C�-S . CONTRACTOR LIC. #(REQUIRED): S � ,j %L% . CITY OF EVERETT BUSINESS LIC. #(R QUIR � ' PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) -- - C�NTACT NAME: j� �n��p� Q' % � S. � CONTACT PHONE: � - , � —� � � � J/'i � �V /' / CONTACT EMAIL• � C�.� (Lo C �// C (f ( S C G't,QIC � AGREEMENT.' T hereby certify that I have read and examined this application and know the same to be true and correct. AI! provisrons of /aws and ordinance governing this type of work will be completed whether specified herein or not. The granting of a permif does not presume fo give authorify to violate or cancel the provisions of any other state or /ocal law regulating consfruction or the perfo�mance of consfruction. That l am authorized by the owner of this property to perform the work for which applicafion is made and l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. r er/Autiiori�.d"Agent Sign�Yur� Date Cify of Everett Official Use Only FEE � - �� PERMIT # � �c�o� — z� � (Revised 10/12120?5)