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LECTR CAL PErtAillT AL,ICATION <br /> mi <br /> mi✓ i- -r CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT MICE INFORMATION <br /> PROJECT ADDRESS: /&-01- /ivripoevr ,2 11~77- ail/4- c1Szoi <br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ET-COMMERCIAL <br /> USE OF BUILDING: Orn:"--/ <br /> '.. . :.. ELIEC' 100471 A.0100,110 iIMFORMA;TIOAI .:,: .,1,',',..:._•:;,:,„:-.:,::,.Y <br /> CONTRACT PRICE OF WORK:$ Z6004'6. . <br /> NUMBER OF DEVICES (if low voltage); • <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: LNveTiffLe, L/64-1-7-5 &NO ageep We-w$ 1-:;,.-z- /`l -to W4ce <br /> c -- D2S <br /> CONTACT INFORMATION ' <br /> OWNER NAME £u,fJ,e/sa v149004-4.- . -- ----›.-TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C,7ZA V/7o �%Lecria G - <br /> CONTRACTOR ADDRESS: STREET F19 eoic 07700 <br /> CITY �i�Vev-- 'T STATE 44)14- ZIP 90„ 13 <br /> CONTRACTOR PHONE: 475 Z57., 'A= •►TRACTOR EMAIL: gk'2fhi--er/edr/Gb9no/a'lL-i &vi. <br /> CONTRACTOR LIC.#(R t i RED): z'a r-� " I OF EVERETT BUSINESS LIC.#(REIT QQUUIRED): 0Z4,V <br /> PRIMARY CONTACT: ► =c- IR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: f06—�?Af,.... /�, o <br /> e CONTACT EMAIL: 7 <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 /> 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> • /17 <br /> / PERMIT* <br /> .�� L �� E \ Q2 - 2C IA <br /> OwnerlAutiiorized Agent Signature Date . (Revised 10/12/2015) <br />