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<br /> C1TY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVER�TT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 j (E) everetteps@everettwa.gov � www.everettv✓a.govlpermits
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<br /> PROJECTADDRESS: � �j(�� ,v ' � i' G - �.r�7 ji1�Gf1 d-``�
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL
<br /> USE OF SUILDING:
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<br /> ����`�'1����L�.��'I�I�d��`�9�� 06�I��9�GF��`�'D+�i�9
<br /> CO�ITRACT PRICE OF VVORpC.$ ������
<br /> NUfV1BER OF DEVICES (if low voltage):
<br /> F1RE ALARM? ❑YES NO
<br /> ASS�CIATED BUILDIPdG PERMIT#(if applicable):
<br /> DESCRIPTIOtd OF WORK: ;� � /I , ��j , �-f .
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<br /> _ : . _ ; .,CON7`AG'I' IIeiFORMATION -
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<br /> OWNER NAME: {j , � �� � TENANT NAME(ff Commercial): �� �n
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<br /> OWNER MAfLING ADDRESS: srReEr � 7 D /�.A„,�7 � c_
<br /> CIN �1/�i��%� / STATE (/%�Cl ZIP I' �� ��
<br /> OWNER PHONE: OWNER ENIAIL:
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<br /> CONTRACTOR NAME: ac,�J ��, ��C f ; ' c_
<br /> CONTRACTOR ADDRESS: sTReEr / C�� � •;��-�G
<br /> CIiY ; ' �/G STATE ZIP �/
<br /> CONTRACTOR PHONE: �' � �/' -�i -' CONTRACTOR EMAIL: ��m ,T�� � C,��-L� .� n , ,� �v�
<br /> CONTRACTOR L[C,#(REQUIRED): �„p G ��
<br /> ��� CITY OF EVERETT BUSINESS LfC.#(REQUIRED}: �(� �'
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<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �n�� - � � - /C' � �� �
<br /> sa�, _�' �,/S �Z- CONTACT EMAIL �� � IrC� C .�c_ ,.�-/? i��L (_'�.-✓i
<br /> AGREEMENT.�T hereby certrfy that l have ad and examined this application and know the same to be frue and corre t. All provisions oflaws and ordinances governing this
<br /> fype of work will be completed whether specffred herein or not The granfrng of a permit does not presume to give authorify to violate or cancel the provisions of any other state or
<br /> locallaw regulafing construction or the parformance of construcfion. That l am authorized 6y the owner of this properiy to perform fhe work for which application is made and 1
<br /> comply with the Sfate Contractors Law 98.27 RCW and 296.200 WAG.
<br /> City of Everett Officral Use Only
<br /> FEE
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<br /> �J� _ _.._f PERMIT# —
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<br /> Owner/Aut ed Agent Signatur �..-- �ate (Revised 90/1?J2095)
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