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14125-2-70/ 9MI <br />30-2 7 <br />(P) 425-257-8810 <br />A1411 �-] Mr, ISM71, W-1101 lljrl�� MUMMA 1411 1*41 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwet.gov1permits <br />le <br />PROJECT ADDRESS: <br />BUILDING AREA (if residential, new construction, remodel, oriofflon) SF <br />BUILDING TYPE. 11 SFR-DETACHED 11 SFR-ATTACHED 11 DUPLEX E3 MULTI -FAMILY - # OF UNITS.,-- COMMERCIAL <br />IUSE OFBUILDING: ,T116_ E{l�P_E'rT- <br />If:, , Vj,"P <br />H113 <br />CONTRACT PRICE OF WORK. <br />NUMBER OF DEVICES (if low voltage):, <br />FIRE ALARM? L1 YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: <br />Y <br />% <br />OWNER NAME: TENANT NAME (if C6mmercfal). lj <br />OWNER MAILING ADDRESS: STREET BOX 5W <br />- d&2 CRY �L' �IF STATE ,�2207 <br />EMA IL: <br />OWNER PHONE: OWNER <br />. I I . <br />CON NAME: <br />-TRACTOR <br />CONTRACTOR ADDRESS, STREU PO BOX -4& <br />eeryma'v_ MIZED IrATAVIA IP!q9Z49-4 <br />CONTRACTOR PHONF-,� -:?- -4-1,014Y 1zMAIL: k,+)e-l. CONTRACTORr <br />coNTRAGTORLIC.#(REQtJ1RED): CITY OF EVERETT MUSINESS LIC, NREQUIRED): <br />PRIMARY CONTACT: nOWNER WCONTRACTOP. El OTHER (Please Specify) <br />CONTACT NAME: <br />. -w-tqN15 6p-ow <br />CONTACT PHONE: <br />CONTACT EMAIL: 10 k1k-141M 60M <br />AGREEMEN7' ''hereby cerfify that I have read and examined this application and know the same to be true and correct Allprou1slons oflaws and ordinances governing this . <br />type of work will be completed whether specAled herein or not. The granting of pannit does not presume to give authofflyto violate or cancel the provisions of any other state or <br />local jawragLilafing construction orthe performance of construction. That I am authorized by the owner ofthis property to patform the work for which appikaflon is made and <br />comply with the State Contractors Law 18.27 ROWand 296.206 WAG. <br />City OfEverett off1cliel Use Only <br />-6;Z , �A. or zed Aganhignature Date <br />FEE <br />PERMIT# <br />E�OV--- MD I <br />(Revised 10/12*015) <br />