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LLECTRIC L PERMIT AI 1nnCATION <br /> I► 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.govI www.everettwa.gov/permits <br /> PR JEGT 6mtki IihOilaMAi'ilc <br /> PROJECT ADDRESS: 1109- LA9W&'It 1vt 1)6r <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 11900 SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR ATTACHED XDUPLEX 0 MULTi-FAMILY-40F UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: •— re5teikihn.C:e.s • <br /> tL edtritirCAL,APPLICATION 1iNF®RMA`10:id <br /> CONTRACT PRICE OF WORK:$ Q 0O <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES VNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: W'1(j. PJt tt) Dar -oM �•(Vcf�iic � 7 91-14-r3 (i) <br /> 1001+ $4 paw/CS 0-) <br /> N <br /> CAT C <br /> .. .. . - . .: :.: ..,:� A -rlit[FORMATIAN- ` ` <br /> OWNER NAME: �.q,$k1 tL(titi Lit TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRgSS: s,T3EET PO ;x -7(L. <br /> CITY cAkti+6l111 STATE vv 1 ZIP ? <br /> OWNER PHONE: OWNER EMAiL: <br /> CONTRACTOR NAME: j�. 'STfF r S. i/tA LLC <br /> CONTRACTOR ADDRESS: STREET 57 I 1.1 AVE Ag <br /> cITY IAC S n5 STATE (A n Yeu ZIP 74,4513 <br /> CONTRACTOR PHONE: q7,5" 121 191./7 CONTRACTOR EMAIL: la 5t45 <br /> eltairf fi44041 4 6984A, <br /> CONTRACTOR LIC.#(REQUIRED)•L oit�'tj5E.t c,3,..u ... <br /> CITY OF EVERETT BUSINESS LIG.#(REQUIRED): O <br /> '��. ..__��... .::�_-,.......�. <br /> PRIMARY CONTACT: ❑OWNERONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t/25 32:7 7 Cf47 <br /> �` Jcç ,(( CONTACT EMAIL: G,�'�y '�G e!Ll �'iti9c/ 0141/ , CA91"L <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 aM 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 lam 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 /> Civ." 1.'02 <br /> ISO I 1 -7 <br /> Owner/Authorized Agent Signature Date (Revised 90/9212095) <br />