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IC AL PERMIT AJOLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> C77- <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFO MAT9'iN.;:• .. `_:' ` <br /> ..: .. ... ... . .. . : <br /> PROJECT ADDRESS: '/ 3 v ��err�� t / 8/4, / S-0 <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> !BUILDING TYPE: 0 SFR-DETACHED D SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: )'COMMERCIAL <br /> i USE OF BUILDING: C-•�u ti c LTL L(Gs• / <br /> ELECTRIOAL APPLICATION IINFORMA` ION <br /> CONTRACT PRICE OF WORK:$ • 2./ SUI) <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? D YES ,G'i4O <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Lha - 71, 1 SA <br /> // <br /> 3 <br /> J/1 <br /> t)/A...-1kl-lake <br /> LU v►fil•e C-�~dc�.S �'� D C-2_ —7"-(4 y'r'1 i-1G�/G_ <br /> 1 ' <br /> CONTACT:NiFORMATI®N <br /> OWNER NAME: TENANT NAME(If Commercial): % <br /> OWNER MAILING ADDRESS: STREET <br /> COY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL:M <br /> CONTRACTOR NAME: �VJ�r(� S CX4- TaI G C.-- <br /> CONTRACTOR ADDRESS: STREET /Z+-/2.3 /684 s, /vl /'" <br /> Aew A.1W �� CnY STATE /QI ZIP `"7 ?"2-2.-3 <br /> CONTRACTOR PHONE b— 4 p- 3 q-S'3 CONTRACTOR EMAILv4.Lf .r s L(e 1/rriL 5 tivcc't f <br /> CONTRACTOR LIC.#(REQUIRED)IMeygivg.cI CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Gy3 �y <br /> __- <br /> PRIMARYCONTACT: 0 OWNER Ip'CONTRACTOR 0 OTHER(Please Specify) N <br /> CONTACT NAME: CONTACT PHONE: (7 ' Zv _ 3 3 <br /> /49/e e CONTACT EMAIL / <br /> /-4 4���..-?-� IiLtfet, <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true( <br /> and correct. All provisions of laws and oydinances governing this <br /> type 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> F `S03 _ot q-- <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />