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A`:..... . �l'RICA , PER ''rIT A.• : ,TION
<br /> ►' ;:r-r 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 SITE IIF TION
<br /> PROJECT ADDRESS: . 3 larisA .,,,R -N OZr .C?yl , , .Ave. . . -Evexte. Vav'c i
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) , is;.'a)i SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX dki MULTI-FAMILY-#OF UNITS: y`, 0 COMMERCIAL
<br /> t '
<br /> USE OF BUILDING: :8'!par4tmetirr +16
<br /> CONTRACT PRICE OF WORK: $ , ;, ; ); ,'`
<br /> NUMBER OF DEVICES (if low voltage):
<br /> —
<br /> FIRE ALARM? 0 YES !kr NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> (ptai2,;
<br /> DESCRIPTION OF WORK: VT plale-e-1 2 ‘.y.42 .., / .. .m.,
<br /> .. .
<br /> COWA T 4 w
<br /> OWNER NAME: q t ° TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS:: STREET ! i ( :airtie41 \ ,
<br /> CIN STATE Y.'Y;i.F. ZIP 1 0`;,
<br /> OWNER PHONE: 4,25 '3`-` OWNER EMAIL: , t' t-s;. `; Jy�r / i,>.
<br /> ., a �tffl k,', hi)t +� ,� ,F1Je ;, j• �6 k,..max.?,� i nJFS+ �, fr,,•
<br /> 7 ' i �.
<br /> CONTRACTOR NAME: --.1-: 4 �y. v. ) �., tr1'.. f, ‘ .
<br /> ly gam,- ..1..
<br /> CONTRACTOR ADDRESS: STREET ➢ ,;.,, !
<br /> CIN 1.. .I� C''j°„ STATEt ZIP VY
<br /> l �6 i
<br /> CONTRACTOR PHONE: . CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC #(REQUIRED): I ' .. t CITY OF EVERETT BUSINESS LIC.#(REQUIRED):40501tCt
<br /> PRIMARY CONTACT: 0 OWNER (°p''CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: `-=wpt 3 ,,', „ ',;?_0 )
<br /> ti
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<br /> ( .i L4II V CONTACT EMAIL: ,Y ,",l' . (e. # f i"1' !
<br /> {`•� , a x. >r a'?.'.''..� -��'PS �r��.{ �) `.,)I i.^s 4, of�, b!i e 4 '� i AA'
<br /> AGREEMENT:/hereby certify that I have read and examined this application and know the same to be true and correct. All protei 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 WAG.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> I'tL , 7tOhl EQuo,R - O&7
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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