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TRICAL PERMIT APFCATIftN
<br /> ''ACITY OF EVERETT PERMIT SERVICES
<br /> 4 �c
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT:SITE I1 ORMATION ` •
<br /> � �, }
<br /> PROJECT ADDRESS:, V, b } f Y "�T.:►,vf�' e - £,A(i' ki VUIf-e WA9
<br /> BUILDING AREA(if residential,new construction, remodel, or addition) -ipt P SF
<br /> BUILDING TYPE: ElSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX A MULTI-FAMILY-#OF UNITS: . 0 COMMERCIAL
<br /> USE OF BUILDING: /'\, `i;. 's p: L 4111.It.i6
<br /> CONTRACT PRICE OF WORK. $ 'l
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES ANO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> r.S
<br /> DESCRIPTION OF WORK: relakeki '.
<br /> (v‘ vvt,i fS. -?,4 lac. Z. I 14.d' -tii7.t v;S Yew,efJ -mac
<br /> HA 1 a,(--(4- - rep w1
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<br /> OWNER NAME: • yp TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS •' r STREET I ', :A \Nt,
<br /> 4.:, I. t . .
<br /> CITY i ..C.A i f STATE ,. i'r, ZIP i`4)c"...;
<br /> OWNER PHONE: 'I. ? i�.. , „r•�a 'iw;,' OWNER EMAIL: �''� ° i.i ?u r, }
<br /> vK.it*.3,i}',7,). !. t/i,�31 It )��., Air.��3 f 6 i %k1�3 ii' / 'Mfr/
<br /> CONTRACTOR NAME: ?' ..1..(ill,' 'k4 I i .�, I r a "; .(;44 w
<br /> jiD,,.
<br /> CONTRACTOR ADDRESS: • STREET f ,� -',,L1:6 f a S_._,a \
<br /> �'= TVA ,y 0 j,•
<br /> CITY L •;4144` 'a`�'n STATE ZIP it,,,-
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<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC #(REQUIRED): N CITY OF EVERETT BUSINESS LIC.#(REQUIRED):D6;U12!
<br /> PRIMARY CONTACT: ❑OWNER i J CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: , ..£,, )" ;J.)
<br /> NLe, �r�,f CONTACT EMAIL: 3 _
<br /> g L e4� Y L e f V I 1 V �1 5 i.� 1p :. .a 5w 4,.�l� r {,i..x �/ .... l .'t i it l`Yr'.�1a i .4.Iz' ,
<br /> AGREEMENT.:1 hereby certify that I have read and examined this application and know the same to be true and correct. Al!prom&ions 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 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> 24 E V10 o70
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
<br />
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