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<br /> ELECTS ICAC, PERMIT APPLICATION
<br /> 'I�►�'a CITY OF EVERETT PERMIT SERVICES
<br /> 11/
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425••257-8810 J FAX 426-257-8857 ( (E)everetteps@everettwa.gov( www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: "" /0,. 6,./..24,4(111rf .°L,/ —'9
<br /> BUILDING AREA(if residential,new construction,remodel,or addltSF _
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED CI DUPLEX Cl MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING:
<br /> OE. '1�G
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<br /> CONTRACT PRICE OF WORK:$ fc�j OQp
<br /> NUMBER OF DEVICES(if low voltage):,
<br /> FIRE ALARM? CI YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if ap licable): }
<br /> DESCRIPTION OF WORK: ;gee pkx.geJ ,1.2j9
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<br /> '�•- vti .. r .Q,OkACT,'INFOt171AT■■yO _, . f
<br /> OWNER NAME: TENANT NAME(If Commercial): BCeliti6
<br /> OWNER MAILING ADDRESS: smear Pa ,fox 37o7 /
<br /> crrr .Jt i 7T��r • STATE
<br /> t yV4 v8612q 2267
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<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ( ij ii-, el,P5 eLie... . 010
<br /> CONTRACTOR ADDRESS: si r Pa $D)C 4/
<br /> MIA* ZIP Ivali
<br /> CONTRACTOR PHONE:426-214 44 CONTRACTOR EMAIL: k/ll�f. H4 mE-giP kitlfilir.
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<br /> CONTRACTOR LIC.tt{t2EQUIRED: ;N 4O z CITY OF EVERETT BUSINESS LIC.#(REQUIRED:0405
<br /> 05
<br /> PRIMARY CONTACT: D OWNER RE CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: p / CONTACT PHONE: 204,-73 6 -654
<br /> , D NNI5 C4DIA/ CONTACT EMAIL: DENMiS.d.gQ1 0 kI114/f!r. &M
<br /> AGREEMENT•T hereby certify that 1 have read end examined this application and know the same to be true and correct Ail provisions of laws and ordinances governing this
<br /> type of work wilt 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 otherstate ar
<br /> focal law regulating construction or the performance of construction. That t am authorized by the owner of this properly to perform the work for which application is made end I
<br /> comply with the State Contractors Law 98.27 RCW and 298.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 8e?
<br /> GAO
<br /> PERMIT#
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<br /> Owner/Au or d Agsn Signature Date (Revised 10/92/2096)
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