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LLECT ICAL PERMIT AI _KATION <br /> 4I�✓�� 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 www.everettwa-gov/permits <br /> 1) ciLIEC 1':.SITE DWI R ATI <br /> PROJECT ADDRESS: 1 C..��'`t }6� ' --1* ( <br /> , <br /> 1 I <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 'SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: € 1 I- <br /> i <br /> USE OF BUILDING: 001, <br /> C TICAL PPLICAT1Old II�1FORir�fA`�'IOI�.. <br /> CONTRACT PRICE OF WORK: aCSC)4i' <br /> NUMBER OF DEVICES(if low, oltage): <br /> FIRE ALARM? 0 YES • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: • ., <br /> . .. . <br /> .. ... ...:. <br /> -• : . CONTACT-INFORMATION <br /> :.-:. . ..,:... ..'.,: :.. <br /> OWNER NAME: Clt <br /> A . t. ^,1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET' 1 y ( (3� W 4t l l �} ,J <br /> cm, Eve4.3z:14. L STATE AQ ZiP ! � `7 <br /> OWNER PHONE: 5Z4 y,n �� OWNER EMAIL: C 11 <br /> CONTRACTOR NAME: <br /> . �, .. <br /> CONTRACTOR ADDRESS: STREET tR( ,UudC C27\-, <br /> CI STATE wog ZIP7 <br /> CONTRACTOR PHONE:740 3 l jsL. CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): (�7 / 7 .#(R 9g"Z <br /> a� _.,::. :-�.�nr,.,....,�,...!,..r..�-(�Z,......CITY ...��..,,:.._. .� _-.,... <br /> OF EVERETT BUSINESS LIC E PRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: sto <br /> z..e„s CONTACT EMAIL: <br /> AGREEMENT:T hereby ce _f 1 have read and examined this application and know the same to be true and correct All provisions of laws 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 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 100 - <br /> PERMIT <br /> # <br /> - =� 7407 <br /> I .-og g <br /> Ow ,f-1K • Signature to (Revised 10/12/2015) <br />