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,������o��� r����o����������� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />� P�3��1��`P �9�� 9R�FOR�A�IOR! <br />PROJECT ADDRE55: <br />BUlLDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UN <br />� -- - .., <br />U5E OF BUILDING: •~' <br />b%5a'�.�., ^ �'� � <br />-- �4 ---- --- --- — <br />❑ COMMERCIAL <br />.;�.�CT�IC�#L A�PLIC�47'OOi�9 1F�9FORili1�,T10P9 <br />CONTRACT PRICE OF WORK:,$' . _ <br />NUMBER OF DEVICES (if low'�olfage): A' <br />FIRE ALARM? ❑ YES ° ❑ NO = � � <br />ASSOCIATED BUILDING PERMIT�-(i�applicable): <br />DESCRIPTION OF WORK: � ; _, <br />�. . � _ F R A N _ <br />OWNER NAME: , s ,- •� -� .�.;- TENANT NAME (If Commercial): ;+, � <br />OWNER MAILING ADDRESS: sTREEr <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAfL: <br />_ ,... . _ _,_.: . . ... _ „� . . ...... :.... _..:. <br />�......�--.... _., .,.:.._._.. __:_ ...,-..�......., ., _ _._...._ _.._...: <br />- ..:,. . ..._..__. <br />... ._: _ _. � <br />CONTRACTOR NAME: ' pY\� ,�;L�^ <br />CONTRACTOR ADDRESS: srReer / €" ; <br />CITY >�V STATE . �•. �'. .�� � ZIP , ;,�ej+�' ''.-- <br />CONTRACTOR PHONE: � �'� CONTRACTOR EMAIL: k � 'r d ° ` t A !'��' ; " �' ~N'� <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BU5INESS LIC. #(REQUIRED): <br />PRIMARY CONTACT; ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />`` CONTACT EMAIL: +','��•-4'�� , ; <br />AGREEMENT.' T hereby certify fhat I have read and examined this application and know the same to be frue and correct. All provisions of laws and ordinances goveming this <br />type of work wiU be completed whether specifred herein or not. The granting of a permrt does nof presume to give authon(y to violate or cancel the provisions of any other state or <br />/oca/ law regulating construction orthe performance of construciion. That l am aufhorized by the owner of thrs properfy to perform the work for which application is made and I <br />comp(y with the State Contracto�s Law 18.27 RCW and 296.200 WAC. <br />�./7 ; � <br />. . <br />OwoedAut(iorized Ayenf Sigtrature <br />Date <br />City of Everetf Official Use Only <br />FEE <br />`� �_ <br />PERMIT # <br />� ����--Z�Co <br />(Revised 10/92/2095) <br />