3003 W CASINO RD BLDG 40-24 2022-03-17

M,925-tk27.001 (,52737� (P) 425-257-8810 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425 257•-8857 1 (E) everetteps@everettwa.gov J www.everettwa.gov/permits PROJECT ADDRESS: BUILDING AREA (if residential, new construction, remod , or addition) SF BUILDING TYPE: © SFR-DETACHED CI SFR ATTACHED 13 DUPLEX 0 muLTI-FAMILY - # OF UNITS: COMMERCIAL USE OF BUILDING: OEM G EVE is J. r�ok .1 .•� x. 3n4C•:..... CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? Cl YES X NO ASSOCIATED BUILDING PERMIT # (if a Ilcable): DESCRIPTION OF WORK: :•3 .,. - • : ... , _;CQ)M`i'ACT`IN)FO�t1�lATiQN:'..t . . , . -. -•- <<: ., OWNER NAME: TENANT NAME (if Commercial): ly OWNER MAILING ADDRESS: STREET CITY Q � lr STATE W� ZIF J IZ • 220% OWNER PHONE. OWNER EMAIL: CONTRACTOR NAME: / CONTRACTOR ADDRESS: SrREaT too $0X CITY M09IL[. STA•rA4 ! ZIP G CONTRACTOR PHONE: 5 21 JJ " 4 21 CONTRACTOR EMAIL: 1 , MEA 1 / %Y� CONTRACTOR LIC. #(REQUIRED): &6A1 , C q0z 1CD ', CITY OF EVERETT BUSINESS LIC. #(REQUIRED): Q'D$ PRIMARY CONTACT; ❑ OWNER M 9 CONTRACTOR 0 OTHER (Please Specify) CONTACT NAME: V/ [CONTAGTPHONE:6P.b ONTACT EMAIL: DEN14 IS, T • e.OiYJ AGREEMENT.• Thereby certify that l have read and examined this appllcatfon and know the same to be true and correct. All provisions oflaw.s and ordkances governing this type of work will be completed whether specked herein ornot. The granting of a permft does not presume to gfve authority to violate or cancel the provisions of any other state or local taw regulating construction or the performance of construction. That 1 am authorked by the ownerof this propedyto perform the work for wh>ch appllcation is made and l comply with tha State Contractors Law 19.27 RCW and 296.20d WAC. OwnarAA orized Agen Signature Date City of Everett of aiat Use Only FEE 005 /n MIT* \ ck k (0 - 0 r-2- ®r-, (Revised 1011212016)