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<br /> CTRIGAL PERMIT APCATION
<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 ADDRESS: f.(D O n t tile, 4'1/
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: IR-DETACHED '';❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ' 0 COMMERCIAL
<br /> USE OF BUILDING: t"1.!el �l K C,L
<br /> CONTRACT PRICE OF WORK:$ OFNUMBER OF DEVICES(if low voltage):
<br /> FIRE'ALARM? ❑YES
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 61‹..c.-- PC-AGc (Q-v-,s`f) -(
<br /> %;� / / /„ ,/ „,,, ,// rim ,:i ,. .iy ,.r�i a � „ /// //9// /// /// 7////�” ../ /(i /%i
<br /> 71,6
<br /> •,,,,,,,„,,,,„,,,c- .... /,,,0%,....4'
<br /> %/ y Y / ,/ / i, %/ � a z z;,r,'„r f i /ice ,i,;/�/iiieo/ii/ / y,%!iiii
<br /> OWNER NAME: ; &(,i4- (--t, a J el TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET /PPfikC71-p.w' /?-ke
<br /> CITY !Y V-€ ‘l'.., e STATE i'v I4 ZIP 9tZ 0 l
<br /> OWNER PHONE: i 6' q f i '012-171 OWNER EMAIL:
<br /> CONTRACTOR NAME: G/A %7�- &Z- Pe-Ae----
<br /> CONTRACTOR ADDRESS: STREET /�'70014 L NO 44-' id,/41. &J&
<br /> CITY t-OA a�{'� STATE C4 .1Z/,\ZIP � �..
<br /> CONTRACTOR PHONE: g 8.0r�s-Y\(9-.)tr CONTRACTOR EMAIL: r/(`��(CE(a!(/f cAd em.4 iCt,•[C- ,GJ'
<br /> CONTRACTOR,LIC.#(REQUIRED); L i "t%'&--S-' -C tA.&> CITY OF EVERETT BUSINESS LIC.#(REQUIRE'. : 11 01Oq
<br /> PRIMARY CONTACT: NER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ( CONTACT PHONE: 14&_c----s9 g7s---a7 ;
<br /> tAL bfN0E3(/ CONTACT EMAIL: OA((( 4)c t e.,1 dr t c . Ct71y-
<br /> AGREEMENT:l hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
<br /> 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 I
<br /> comply with the State Contractors Law 18.27 RCW and 296200 WAC.
<br /> City of Everett.Official Use Only,
<br /> ® PERMIT#
<br /> I 1�g E 1 �- p �
<br /> Owner/Author d A.-nt ignature Date (Revised 9/23/2016)
<br />
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