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110 <br /> .4.0.,,,,A,v/w5-4 <br /> CITY OF EVER l i I PERMIT SERVICES <br /> 3200 CEDAR STREET, EEVERE 1 I•WA 98201 <br /> {P}426-2 7-8810 I FAX 425-257-885T [(E)everetteps( ierei gov 1 vim ewers ovfperrn' <br /> ',PROJECT DM1�&: S t i 4a� d Avf E were 1-`��+,� . _ _ 9 <br /> S}t G ,of rs sxciontiai,IIGIV cons#h o ior�rernodel:or add'.,n) F <br /> 3ilELCtF3f r Pte_ `' <br /> :, sFR-DET#•O Ej L SFR-ATTACHED Ill DUPLEX D i'r LT1-FA11AILY_#OF UN6S- E'1COMMERC1AL <br /> 111.3SE OF StSSLO 4dg <br /> -- <br /> 1:E...... ' n`CAL API'LBOATII tit IIRr. •lria <br /> NTTci PRICE OF u 50C { <br /> • <br /> Pili UIVIl I OF DEVICES(If low .oItage): <br /> FIRE ALARM? C YES IR NO <br /> ASSOCIATED EU/LOING FERIVI1T#Of a,*kale= k <br /> .;D S Ri ! OF ow w`‘VC, S . <br /> ., __._ <br /> ACT I :It- TI.g.til <br /> ,OWNER NAME.: . s s o is ilio y . TENANT NAME Commercial): <br /> 10INNER NIA,ILIINI's ADDRESS 5.,%eer. <br /> li <br /> O ER PHONE. OWNER EiW.Aii» r <br /> 'ct NTRAC 0R I&AlflE: CA - .r.‘;.1 1 Y'"`lt gg <br /> ADDRESS: sr i s"` tet, 1-c•V 9 0 ^`a.-' q.:'� <br /> ;CONTRACTOR <br /> w� <br /> <--M.• '" 1, c.�-v.. .,l sTA r'A 10' <br /> -.41111116 <br /> cots T RAOTQR PHONE: 3(: 3l.f)Ca q 33 COO .nea rtcl rv.n er c ( �- <br /> Gti l T r.'CTt2ic I~i REQ[JiRE r`tSc,u , <br /> J <br /> ' 3 ¶ci i C xl tom`OF �.#(R QUIRED O.9 U <br /> 'P I IIllARY CONTACT: 1]OWNER IXCONTRACTOR T CTCR I OTHER.(Pieuue.Smelt-ill <br /> t <br /> CONI G i Al G 3itTI1 G PHONE: .4 <br /> LSF tt x � [ <br /> ,"4\C _- v ti..._.r{'c"� co118 I' C T ENLIL: <br /> rasa;��le ' «r •r3r"1'T—et rrs <br /> AGREEMENT:t rsenb rcedgytnatl have read arra examined this application and know the same to be true and Wile=Allptowisionsoflaws and onliaanias governing this <br /> type at work fl be c rnpl Let ter ed harm r arnr Thegcan8ng ofapemritdues notpianos to glue,authanlyi arsancatthe pmvr.im m tfarry oftier leieor <br /> 1nc3Elartregni ing wawa= ina pedomiance ofcnnatmeitom Matt am azithafized bythe myna r affhie pmp yip it , ras fhs Meg rsgPIuu icn ism de and'I <br /> :comply ern the State Ganfr efars t err?8.27 RCW and 29a2oo V#AG <br /> City of EvertOffleial Use Only <br /> FEE <br /> . 21Z)0 iii, <br /> pMrr <br /> _ 1,ket.. i c 0 9 h Vi E 1'4-0c1 _ °9 <br /> ..A.41,....,,,Agent Signature Date <br /> (Revised 10112121)75) <br />