10627 19TH AVE SE SILVER LAKE ORTHODONTICS 2019-06-11

• C LC CCTC L PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES --�' 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: i 6.6 7 114k Ave v\Lke SE, E,� E°e v efi-� , �,JA 9-3D0 5 uot); X BUILDING AREA(if residential,new construction,remodel,or addition) t 6 7 ► SF BUILDING TYPE: 0 SFR DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: t .COMMERCIAL USE OF BUILDING: 0 y - p A O i& -c c S fio...-c -- \'c . • ELECTRICAL APPLiONirW®N INFORM91A` WN CONTRACT PRICE OF WORK:$C` D 3 /00 0 NUMBER OF DEVICES(if low voltage): 1 8 FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): !) go 031- . 31- DESCRIPTION OF WORK: 0 Y t tkekt e I e..l fZd c r•P q cam;v-2 a p 11e,C f tr i s o, I cJo r lc c1 S t I V?v' Lo.r 2 U r-t•k0 km/0 c 4 , _rtA.c f rk_ / (--0a,0 On I • _ ;: .:CON'TACTINFORMATION. : :. . • OWNER NAME: TENANT NAME(If Commercial): 'I(c/P✓ l of> ov f A o Jowl-I r S OWNER MAILING ADDRESS: STREET (0 ,A) o t f t C 5'a-• (A'\\*+ 0 CITY SSTATE 1JA zip y1 U ' a 15 OWNERPHONE: O Ddd C .OWNER EMAIL: owvi al i I � C 0 ON CONTRACTOR NAME: Tv\ 'E t e C-- v'i c_ S€2✓'U 1 c€S ( 1 CONTRACTOR ADDRESS: STREET •ed r q I g k A v Qy . SE crry %v et,.)Cos•} 1 Q, / STATE C,,j A ZIP ergo 51 CONTRACTOR PHONE: 0 6 — 7 7 a- 1 a`- CONTRACTOR EMAIL: 5+e T K O kc SA C:\ \v\O U e ,vt S h. tom CONTRACTOR LiC.#(REQUIRED): CITY OF EVERETT BUSINESS LiC.#(REQUIRED): PRIMARY CONTACT: CI OWNER 0 CONTRACTOR I2'OTHER(Please Specify) p o,v,.w•N 6 P Aon lio. C`�\$��-7`(-Y-—(473 CONTACT NAME: CONTACT PHONE: J CONTACT EMAIL: AGREEMENT:T hereby certify that!have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 5Th C('"? 017 v'' PERMIT# 44111111111L7 7//g F ifb(10- 9) Or Owner/Authorize. .entSignature Date (Revised 10/12/2015)