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ECTR1JCAL PC 1R{V'IT I PHI i IC',1100 <br /> F ` CITY OF EVERETT PERMIT S Y CES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 J (E)everettepsga everettwa.gov( www.everettwa.gov/permits <br /> 10:4640SlI1t IIGfr®+tit iA i{s4 <br /> PROJECT ADDRESS: 12(A --,701-1.'› <br /> {' �� <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 2, 4 41 SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS 0 COMMERCIAL <br /> USE OF BUILDING: <br /> EthOrtrileALAPPLOOKTOMANIFOItiiiiAlloN <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): • <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1) f O )/J/ cs" ( <br /> • •.. • . . CONTACT INFORMATION <br /> OWNER NAME: ef) / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:' STREET <br /> AD <br /> COY STATE ZIP <br /> OWNER PHONE: } ,4-1.�T`p OWNER EMAIL:I <br /> CONTRACTOR NAME: I��.Y i���If ''� Y 1 I. <br /> � �>l��'t • 1 1� I� . .> , ,.....�.�....„ �_ ........,.... ._ ...,,- ........_-- <br /> Itvy <br /> CONTRACTOR ADDRESS: STREET (l2/L'2/1 1 I/1A> ( o f �?/}ry <br /> CITY La 1! STATE 1/ l t zIP C3t„1?2,...- <br /> CONTRACTOR PHONE: L2,1EI ))X11 ` (0051 CONTRACTOR EMAIL: ,C <br /> CONTRACTOR LIC #(REQUIRED) .•X PPj "I CITY OF EVERETT BUSINESS LIC #(REQUIRED):Utjfmn�' I <br /> PRIMARY CONTACT: Ll OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL. <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 <br /> typeof 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 ortho performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the Slate Contractors Law 18.27 RCW and 296.200 WAC_ <br /> City of Everett Official Use Only <br /> FEE <br /> • g <br /> PERMIT# <br /> Own• Authorized Agent Signature Date (Revised 10/12/2015) <br />