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<br />�� ' C1TY OF EVERETT P�RMIT RVICES
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<br />3200 G�DAR STR�ET, �VFRETT, 1NA 9820�
<br />(P) 42��2�7�8810 � FAX 425-2�7-8857 ](�) everefieps@everetivva.gov 1 vau�rv,r.evere�fwa.gov/permits
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<br />BU1LD1�iG AREA (if residen�ial, naw construction, remadel, or addifion) ��'
<br />BU1LDItVG TXP�: �SFR-D�TACHED CI SFRATT�ACHED �I DUPLFX ❑ MULTI-FAMILY-# OF 1JNITS: �I COMMERCIAL
<br />USE OF BUILDII��; �
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<br />CDN'TI�ACT PRIG� O� WORK; � ��% Z_ �.�
<br />NUMBEF �� D��IiCE� (if low valfiage); '
<br />FiRE �LAR�11? ❑ Y�S I�' NO
<br />ASSOCIATED BUILDING PERIVt17 # (if applicable):
<br />D�SGRIP7ION��� lA(t�RK: i'�C�n �- �c� Fl �`�P Z� L�' `� �-: rZ C�s �� 'i'fl �'� �� 4�
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<br />QiNNER �IAIYIE;'::" ... -(T� ��L' k l� 1�� v��- 0' w''��ENANT NAM� (ff Commercial):
<br />OWNERMAILINGADDRESS• srReEr 1(�%�j r'`c'C�iCP�T���� 1�1�--�
<br />.. ' CITY � L' V`� � STAiE �� ZJP
<br />� OWN�R EMAiL; Cr1� (� 1�1 K-�'O M ��'`�
<br />DWNER PHflNE: ��G ' J "I� ' � � (� � , - - - _-
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<br />CONTRAC70R NAM�:
<br />CONTRAGTORADDRESS: srizEeT `�� 2�� 1�� �'��- S�-
<br />cirr � J�' E' � STATE Lt,� it- zi� Cl����
<br />CONTRACTOR PH07�IE: �I2 � ' �� �d' �3n CDNTRAGTOR �MAtL: � Df�J �= � ° 1> j � ��- � �`�C , fOc"�
<br />. t� �� 3` ` S`b 1�'' CITY OF EVERETT BUSIIU�SS LIC. #(REQUIRED). �� 5
<br />COAITRA�TOR LIC, #(REQUfRED). �L/ 3 � t- l= 1 � _ _ _ _ _ _ _ - -
<br />pRINiARyvCONTACT;rt( Cd OWNER � 1� CONTRACTOR L7 D�H�R (Please Specify)
<br />CQNTAC7"7VAIVIE: GONTAC7PHOtVE: �j�O " j���" �`'L� I
<br />C� � � r� ('� � � � L (�us-� i � CDNTACT E1V(AfL: (� ��2►� t� �) � M C �� �w . c o �-,
<br />AGREEMENT.' T hereby certify ihat ! have read and examined this application and know the same to be true and correct. A//p�ovrsions of laivs and ordrnan�s goveming this
<br />fype of work wi!/be complefed wheiherspecified herein ornot The granting of a permit does noipresume to give authorify io vio(ats orcanceJihe provisions of any ofherstate or
<br />local !aw regulatinq construciion orthe performance of constrr�ciron. Thaf ! am authorized by fhe ov✓ner oi this properfy fo perform fhe tvork forwhich applicaiion is made and I
<br />complyv✓ith the State Contractors Law 98.27RCiNand 296.200 WAC.
<br />C't fEveretf Offcial Use Only
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<br />AgentSignature _ Dafe
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<br />FEE �
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<br />PERMIT#
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<br />(Revised 10/92/2095)
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