2121 MAIN ST 2017-01-13 - Laserfiche WebLink

�1 ��- - - s,,t� _ �� 0� ; � �8�� CITY OF EVERETT PERMIT ICES 3200 C�DAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits . �RO��'Y' SI`T� ��'�Rii9iA`TIOFd PROJECT ADDRE55: � I � I � Jq ) � �� . % ��G f —�. �7 V�� C� f" ) 1 f.-' � BUILDING AREA (if residential, new construction, remodel, or ad ition) SF SUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHE U EX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: CONTACT INFORMATION , ` OWNER NAME; �//�7�� 7'�� TENANT NAME (If Commercial): OWNERMAILINGADDRESS: srrzeEr -� ��;`� .`.' — �..��-/�� i ( � ��! '� L�� %�,��b�; � � CITY � �- STATE ZIP � C ' � � OWNER PHONE: � _ � �� r% �' � Z OWNER EMAIL: ,� -- r�� ' �� t i . l . � 1 J�"1 �" CONTRACTOR NAME: CONTRACTOR ADDRESS: srReer CITY STATE ZIP CONTRAC70R PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC, #(REQUIRED): CITY OF EVERETT BUSWESS LIC. #(REQUIRED): PRIMARY CONTACT: WNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: �� - j C� ) l� ��/�/ 7 / "-J CONTACT EMAfL: � iY- ��, $ ; - � , G _ � AC'RFFMENT T herebvi cerfifv that I have read and examined this application and know the same to be frue and correct All provisions of laws and ordinances goveminq this type of work will 6e completed whether specifred 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 local Iaw �egulating construction orthe performance of construction. That l am aufhorized by the owner of this property to pe�form the work for which app/icafion is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. �//^ � ,��.�',�� OwnedAutfiorized Agent Signature City of Evereft Official Use Only FEE .� PERMIT # � � � �o� �' �-�� ,.s� (Revised 10/92/2015)