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tLECCTR CAL PERMIT V' �CATIIO
<br /> ' f Jf r CITY OF EVERETT PERMIT SERVICES
<br /> , 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-88110 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.govlpermits
<br /> PROJECT ADDRESS: / n 1e,/ re,�j/t �
<br /> BUILDING AREA(if residential,new construction,remod or addition) SF
<br /> BUILDING TYPE: 9 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: '6<OMMERCIAL
<br /> USE OF BUILDING: C�K4(.•Lvt.
<br /> ,: -:000;t0>I0AL .<_�.iPIP�.10:0114;:-I� lRl>���:.lt1.l��'8�!.� ...
<br /> CONTRACT PRICE OF WORK:$ IS 0 0 a '
<br /> NUMBER OF DEVICES(if low voltage):, 4e)
<br /> FIRE ALARM? 0 YES , IO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): Ota"--7,,,- ---
<br /> DESCRIPTION OF WORK: ,,,x-1544.-5---twe °A ® C' -
<br /> - 0?1 _
<br /> .. .. . :
<br /> CONTACT-l<l( )F®RI,1f. T>i®N..:
<br /> OWNER NAME: �,�4 ev-i �S G� TENANT NAME(If Commercial): VCS f�.5 r,Z
<br /> (,ZQ ��.,14 14,E 1
<br /> OWNER MAILING ADDRESS: STREET
<br /> CIN 04 ?7leC. STATE 61Z /et ZIP . 8?
<br /> OWNER PHONE: OWNER EMAIL: .,_ ,
<br /> CONTRACTOR NAME: q (�n14, G'® •. . CSC 1 1 l .,
<br /> CONTRACTOR ADDRESS: sTREEr 9 ( . ) E 'ds)-\-"-
<br /> CITY I �l e STATE 1-.4....."4.-- ZIP7355>
<br /> CONTRACTOR PHONE-S(00.-'/e 0 -,./ NTRACTOR EMAIL: c UI1�Y1(( e_DLL`jki.. of i I I. e -t_
<br /> CONTRACTOR LIC.#(REQUIRED):Q..._ ts",!"b�i,�..,.-�3 ���B CITY OF EVERETT BUSINESS L1C.#(REQUIRED) 4F!
<br /> r�,
<br /> ,�,, .,��, � � ..wv��::.-�L.,.__�-���.-,�..r._Ys,:,�.._:= .�.,-..,z._�.....r.�.._�.-�. ( -
<br /> +PRIMARY CONTACT: 9 OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> C CT NAT CONTACT PHONE: 8C o -- L/70 1. ?,
<br /> }� I ©0. 6 vy..A.L.A___ CONTACT EMAIL: .,10,ltnl.^1,,�Cokvcr/oc.., mat( t ez, _
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws an onijnces 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 other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the State Contractors Law 98.27 RCW and.296.20b WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> . (...4 S ,—.—
<br /> PERMIT#
<br /> e, Air._
<br /> 1 1 fr lAk ifW 7 d 10,y7 E U. -( 0 - 0 q0.
<br /> aawner/Autho fed"gent Sigu .01111..— Date (Revised 10/1212015)
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