6327 POLK PL 2017-01-13 - Laserfiche WebLink

�� : I�'►' �� ��0�� I�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 42b-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE II+IFORMATION PROJECT ADDRESS: � 7j �.,� �� I'� BUILDING AREA (if residential, new construction, remodel, or addition) SF BUILDING TYPE: �I SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: CONTACT INFORMATION OWNER NAME: � z S C', U TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTReeT � 3� � �v � � 1 CITY ��J e;('� �� STATE ZIP / � � OWNER PHONE: �U � � j � ZO �-- OWNER EMAIL: _.. _ _ . __ .. ._ ___. .___ .._. _ . _ ._. _ _... __.... CONTRACTOR NAME: � w' �� V� � I� G ' CONTRACTOR ADDRESS: sTREeT � �Cn � � ( � � Tt �L /�/ CITY LC.[ � T� V� STATE �,.�! � ZIP / is Z ,� CONTRACTOR PHONE: �-- Z� CONTRACTOR EMAIL• �- .r ct� c�; � f„� ,'�, CONTRACTOR L1C. #(REQUIRED): .� � � CITY OF EVERETT BUSINESS LIC. #(REQUIRED): D S Z � PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) C�NTACT NAME: CONTACT PHONE: Z S 3' 2 ,�SZ � �Z � CONTACT EMAIL: , .� ;� f� �. � AGRE MENT.• T he�ebvi cerfifv that I have read and examined this application and know fhe same to be true and correct. ll provisrons of laws and ordinances governinq fhis type of work will be completed whether specified herern ornot. The granting of a permit does not presume to grve authority io violate or cancel the provisions of any other state or local law regulating construction or fhe performance of consfruction. That I am authorized by the owner of thrs p�ope�ty to perform the work for whrch applicafion is made and l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �ZJ I n�� '� PERMIT # ��1�o3-�b� (Revised 10/12/2015)