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<br /> C1TY OF EVERETT PERMIT SERVIGES
<br /> 3200 CEDAR STREET, EVERETT, WA 9820'1
<br /> (P} 42�-257-8810 � FAX425-257-8857 � (�) everefteps@everetiwa.gov] wvvw.everettwa.govlpermits
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<br /> . R�JECT ADDRESS: 'JL(� � � �� �.;'1 � G�-' �'"�' ir�-�I W �. ���C��
<br /> BUILDIAIG AREA(if residential,new consfruction,remodel,or addition) SF �
<br /> BUILDING TlPE: ❑SFR DETACHED ❑SFR ATl"FlCHED ❑ DUPLEX ❑MULT[-FAMILY-#OF UN1TS: COMMERCIAL
<br /> USE OF BUILDING: ����-�� �, � � '� •
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<br /> PIC COi�TR,4CT PRiCE Ol�l�/OR�:$ �j ��l ��� '
<br /> �tUiVtBER OF DEVICES(if fow voltage);�
<br /> FIRE,4LARM? D YES ❑NO
<br /> ASS�CI�.TED BUILDIYdG PERIVIIT#(if applicable):
<br /> DESCRlPTIO�f OF WOR{C:-�- it/ `r,,L.� �
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<br /> OWNER NAME: '� 1 ��,�j ��� �-� EidAN MArit1E f Com ercia!): - ��G�-� �'j
<br /> OWNER MAIL[NG ADDRESS: sraeEr IaJ�� � � � C�s�t �IJ�V. v ���'�--
<br /> CI'fY �(�. 1���L. , ��.I r � I�U STATE � ZIP ✓Z�1 Z� ,
<br /> OWNER PHONE: OWNER EMA[L: ��
<br /> GONTRAC70:R NAME: � Qt� ��'�=�
<br /> CONTRACT�R ADDRESS: srR�r ��J 1�� �P�i1 � � Z�`�
<br /> CfiY ��'�-_�. -l. �-'� �'�.. �l V I��ATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: '
<br /> ONTRACTOR L[C.#�(REQUIRED): �.jClA�l�\ L�� � CITY OF EVERETT I3USINESS LIC#(REQUPRED):
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<br /> PRIN(ARY CONTAC7: 17 OWNER �$ONTRACTOR ❑QTHER(Please Specify)�1
<br /> CONTACT NAME: 1 in.,1iV'�/��-- ����,.Z,�. � ONTACT PHOn[E: �� -' �� O r- C�'�i.- L� �
<br /> � � C D N T A G T E N t A I L: (.� i � r , ��
<br /> AGREEMEhIT.'T hereby cettify that!have read and examined this application and knowfhe same to be frue and co ect All provisions oflaws and ordinances goveming this
<br /> fype of work will be compleied whefher specifred herein or not The granting of a permit does nof presume to give authorify to violate or cance!the provisions of any other state or
<br /> local law regulating construcfion or the performance of construction. Thaf l am authorized 6y the awner of this properiy to perform the work for which appiication is made and!
<br /> comply tNifh the State Contractors LatN 98.27 ftCIN arzd 296.200 WAG
<br /> City of Everett Offfcia/Use Only
<br /> FEE
<br /> �
<br /> PERMIT#
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<br /> O�vnerlAufhorized gen ignature Date (Revised 90/92/2095)
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