909 SE EVERETT MALL WAY PINNACLE DENTAL GROUP 2018-05-17

�LE�TR��►L PEI�NII�T A �L��'�1+C�N �1'I�'t7��V�f��"�"i' P�F;Mi'f 5€RVI�ES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits ` PRQJEG7`S1"�'E INF�RMA110N ' PROJECT ADDRESS: BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: ELECTR�CAL APPLICATLON iNFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low volta e : FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable : DESCRIPTION OF WORK: t �g n � ��1'fi��:'��1�Q�NIATIS�� OWNER NAME: , TENANT NAME(If Commercial: ' OWNER MAILING ADDRESS:� cirr r' s-rn-re zia � G � Q1f11�I�R PH4M�; QWN�R�MAl6.. CONTRACTOR NAME: (� CONTRACTOR ADDRESS: s-rReer � - g �'" cm STATE - 21P CONTRACTOR PHONE: �— — �- ONTFlACTOR EMAIL: aj e CONTR�0.CTOR LiC.�(REGtU1RED): �ITIf OF E RETT SiNES�Lt�.#(REQItiRED)" PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �bTHER(Please Specify) ' CONTACT NAME: CONTAGT PHONE: �� _ q �U L O�- CONTACT EMAIL: ,(,��j ri (I C � C�,i( . Cl�7Y1�� AGREEMENT.•1 hereby certify that l have read and examined this appiication and know the same to 6a true and correct. Afl provisions of laws and ardinances goveming this type of work wiit 6e completed whefher spec�ed herein or not The granting of a permit does not presume to give authonty io violafe or cance!fhe provisions of any other state or loca/law regulatlng consfruction or the perfomrance of construction. That!am authorized by the owner of ihls property to periortn ihe work for which application is made andY comply with the SYate Contractors Law?8.27 RCW and 296.200 WAC. City oi Everett O�cial Use Qnty PERMIT# _ � _� g E bwner utfioFi$� A nt�igna D�te (Revised 9J23J2U�I6)