6133 LAKE CHAPLAIN RD 2017-06-13

ELECT CAL PERNT APeLICATMN CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 J (E)everetteps@everettwa.gov I www.everettwa.gov/permits :t,rr:. :`-. �'IRO�IECY�SITE-�•�I�0➢�t111 'I'IQ7�f � �._' .. "' .., � �, PROJECT ADDRESS: j Lr k4a)=deLj-A 1/ LAA BUILDING AREA(if residential, new construction,remodel,or addition) PAll d�SF BUILDING TYPE: CI SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: 1CCOMMERCIAL USE OF BUILDING: J c., A>P�i��i��►�ioia.l�Foii��Tio� CONTRACT PRICE OF WORK:$ 00 NUMBER OF DEVICES if low voltage): FIRE ALARM? gYES ❑NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: GG COI►I�TACEZMATION' OWNER NAME: GQ TENANT NAME If Commercial): c Q OWNER MAILING ADDRESS: STREET Zdd CITY STATE 7JP 7 2.e5 f OWNER PHONE: rZ'lr S Sa7-oS OWNER EMAIL: k-yt4Dl �M O-� eL ��Q' !see)tl CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: KOWNER ❑CONTRACTOR )A OTHER(Please Specify) G t" CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: a . bt/ AGREEMENT.,T heraby certify that I have read and examined this application and knew the same to be Into and cornocf. All provisions of laws and ordinances governing this type of work will be completed whether spedfied herein or not. The granting of a permit does not presume to give aulhorV to violate or cancel the provisions of any other slate or local law regulating construction orthe port'ormance of construction. That I em authorizedby the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Offlcla!Use Only FEE 2L'I o PERMIT# Owner uthorizod�4.,ItSlflnaturot' Dato (Revised 10/12/2015)