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LLECTR.IC A L PERMIT 1 JCATIO ry <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT <br /> PROJECT ADDRESS: 9(03( /6"-`f'{ ,4v.e It / l/Qre /--- f <br /> BUILDING AREA(if residential,new construction, remodel,or addition) /3 VO SF <br /> BUILDING TYPE: ,ISFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTi-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Pc--; R r.1 side h CCS <br /> a:1-E litd:0A‘•AP14.0CAT.ON WF..RMAT'i®N . <br /> CONTRACT PRICE OF WORK:$ 4//4 • <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: G`r a p,3e,, 4.-7i it Tia i r//n,`f ,otic' e P^�Q r �g 4,770 <br /> ' t_-rea,L/ 1,ap( <br /> A. _ .COIi1TACT:iNFORMATION. `� � . <br /> OWNER NAME: Din, k!f/A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREEr q�p 3jyl�`�/f /R"& A/e / may/ 9 p,9/� <br /> cm( FUe rL. / STATE Lf//,// ZIP /O 2 y <br /> OWNER PHONE: (/Z S 4f 6- 0/Z(% OWNER EMAIL: A.I g,0 J ain�f (�y 14d,C'U/✓I w - <br /> CONTRACTOR NAME: i9 I1/ e <br /> CONTRACTOR ADDRESS: STREET • <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY <br /> `�� <br /> CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) '•,~~-SJ„e'rv.�-'y�.•i�~Kwy�y��w.^.~'.v'�a`~'umu�.'.`^W�wW^� <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 /> 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 l 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 /> r100 <br /> E <br /> o0 <br /> PERMIT# <br /> ///2/ //7 F <br /> Owner/Authorize gent Signature Date (Revised 10/12/2015) <br />