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ILL CTR CCAL PERMIT AP P-LICATION <br /> �✓' rr CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 j (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> P)I�C�DIEGT SIft Ilol(a t MATION :. <br /> PROJECT ADDRESS: 5 0S S€' Euer -c ff- 1441 1/ of <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> TON p>R#F®RMA`I'O 1N <br /> CONTRACT PRICE OF WORK:$ 500 <br /> NUMBER OF DEVICES(if low voltage). <br /> FIRE ALARM? 0 YES gISIO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ( <br /> DESCRIPTION OF WORK: u/d f)S // 7/d i o i'/ 2- S5/A-45/A-4J 0-�f 7 syf/,t r4,,,,, <br /> ' 7 <br /> W/ OM, l .I`O ci {Ce.. c--c-- <br /> - - INTAC <br /> . ....,... .:.. ._. . . ,- : . .. .. : ....:... • .-.:..:._....,.. ...,.'IINF®ItMATI®N.:.`, . . .. :OWNER NAME: TENANT NAME(If Commercial): 54tzy % ,4c/ry <br /> OWNER MAILING ADDRESS: smear / c1tip,o/y <br /> cm' STATE ZIP / <br /> OWNER PHONE: s <br /> ,/�j� OWNER EMAIL: <br /> CONTRACTOR NAME: /f'! (/Z-j4ii j ,A ®� •�. . . + /C�. . <br /> CONTRACTOR ADDRESS: STREET 33/ �/N!®[� `�G( �fl f ,9/�I, " '5 -6.E) <br /> N X73 <br /> CIN E s`l L-l_ STATE -CC ZIP o2 9' . <br /> CONTRACTOR PHONE: num Lo n 1iCONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):3S`-h <br /> PRIMARY CONTACT: ❑OWNER g. ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: E�®1.- — z / <br /> is G`e- CONTACT EMAIL: f Gj q /f i.4 t ( M0 4dMeolf <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this coki <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 f am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> • <br /> FEE <br /> v I o <br /> n/11"14(712f k"." <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />