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E <br />�7 CLCC f 3CAL pCRUQT APRUCATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE RM-FOR-MAT <br />PROJECT ADDRESS: dig liver reer li✓°r <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ S,/FR-ATTACHED ❑ DUPLEX El MULTI -FAMILY - # OF UNITS: COMMERCIAL <br />uSEOFBUILDING: ©rgi</L1'4k10 l`"✓'/� _ <br />CONTACT INFORMATION <br />OWNER NAME: <br />TENANT NAME (If Commercial): 11Q f�j <br />OWNER MAILING ADDRESS: STREET <br />My <br />STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: C71�Jyj %� <br />r►�C L <br />CONTRACTOR ADDRESS: STREET .� �� <br />/e7 ✓2 <br />CITY ►'(r rC W <br />STATE ZIP <br />CONTRACTOR PHONE: `.Z 3 --209 — Z/r 7 ECONTRACTOR <br />EMAIL: a / 1 K e 11` C- f ✓i C R M C41 CO <br />CONTRACTOR LIC. #(REQUIRED). ONNEC-� �I �p h <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER KCONTRACTOR <br />❑ OTHER (Please Specify) <br />CONTACT NAME: <br />9CCJ �'okv)l PV <br />CONTACT PHONE: <br />CONTACT EMAIL: e, ,7 h e frJC �I S/i/, <br />AGREEMENT Thereby certify that l have read and examined this application and know the same to be true and correct All provisions oflaws and ordinances governing this <br />type 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 otherstate or <br />local law regulating construction or the performance of construction. That/ 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 />FEE <br />PERMIT # <br />E 2LD� <br />_ <br />(Revised 1011212015) <br />