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� '; <br />� ,- <br />��� <br />- � �-, � � � � - � ` ' � � '-► '� � � � <br />- , , -�, - � <br />, <br />_ '. � �- � � �.,, � ;? � � '� � -, <br />� - -C . i . <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everetiwa.gov � www.everettwa.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: �- ,� �MS 0�'`J TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREEr � 3 U�' �� ��TU"� "� <br />CITY °.� �/`E'� V��� ` 1 STATE "`� � ZIP � U � U <br />OWNER PHONE: ��-� 3�� 3�� OWNER EMAIL: e-v. S:' '✓ ��(/ iN`� < O�-f I 0 v�<< U v'^` <br />CONTRACTOR NAME: '' W ln �2 � <br />CONTRACTOR ADDRESS: sTReET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />, . ...-. _...._ . . .. ........ . . .:....... _.... .. .. .__...._. , .. .. _ . . . . . <br />PRIMARY CONTACT: L�`OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />"'�`1 uJ � Y� S J'� CONTACT EMAIL: <br />AGREEMENT: T hereby certify thaf I have read and examined this application and know the same fo be true and correct. AIl provlsfons otlaws and ord�nances govemrng mis <br />type of work will be completed whether specified herein or not. The granfing of a permit does not presume fo give authority fo violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 <br />comp/y wifh the State Contractors Law 98.27 RCW and 296.200 WAC. <br />�.�- <br />1y/��r� <br />Agent Signature Date <br />City of Eve�etf Official Use Only <br />FEE <br />C�� <br />�� ,_ <br />PERMIT # <br />E� �� l Z. --� I I� <br />(Revised 10/12/2015) <br />