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<br />CITY OF FVERETT PERMIT SERVICF_S
<br />32Q0 CEDnR STREE7', EVERET'T, WA 98201
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<br />(P) 425-257-8510 � F=AX 425-257-3F�57 �(E) �vpr�ttepsCa�ev�refteva.gov � Urww.everettv✓�.3.gov/permits
<br />,�;,�'�. CQNTA�T INFORMAT[t3N �
<br />OWNER NAME: � ���.f�� �.�,; r<;' t:✓ TENANT NAME (If Contmercial):
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<br />OWNER MAIUNG ADDRESS: srr?�� ��' <) .>% ;;, ,�-� ,�.. ,'�- . ;i �.'
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<br />OWNER PHONE: Y�,.i - � ;� ..i �� �,;�' ,� OWNER EIVIAIL•
<br />CONTRACTOR NAME: /� c> .. J�, � � f.-' %r� t ! - . �. ,L. L. � _.
<br />CfJNTRACTOR ADDRESS: si,;� f r �s�-' c'� .a;y' `�' �:� G
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<br />CONTRACTOR PHONE: �''G% �'- "';'�' � 1 :.; �,� i.: CONTRACTOR EMAIL: �� ..- �'�- i�,.� �'' .'` ' �- �` .' , �,. . ,: r> r
<br />CUN�T'RACTOR LIG. #(K�(�uIF;GD): ./.,� c= *,. �',� Fe'. �' �,"i ,.�� "r -�'�.� �'���� GITY DF EVERETT BUSINESS L(C. #(F,EQU�REDj: C::� ��`i'�;�' s=� �`
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<br />PRIMARY CONTACT: CI OWNER C'�C�NTRACTOR ❑ C�TH�R (Please Specify) ___i_ _
<br />C�NTACT NAME: CONTACT PHONE: t�•,1 j=�j' ,,y� �: ✓; ,r' .� c'
<br />i ",�'7 :,• r: � ,!;~�'�. ,, �' �'''~"� CONTACT EMAIL:
<br />AGf;� ErLSf�r�JT.' r here.hy cc�.`?P,�.'hGt! ��K=ve rnad �na exarnined this apptiea!inn an;� knov.� tha sr3r�rrr ta bcs true t�nd correr.t. ti)! prr,>vis!nns o`l:�v✓s anri ordinanr,r�s gnvrarnir,g tl,is
<br />tV�E of t=la�k ,a�r} be cvmpleied w'I�eth�r,s�.: ,1li��d here�n ur nef- Ttra g��;�ting of e pr,rzntt tici�:y r�r.f presuate io �n�e auti�v�itylo violrat� �;r c7nr,e/ rl�� provisions of any oiher s::�te o�
<br />J���ai iaw rr=_.r.uiatrr,g c�rs?nrdion ort?�e ��tormance of cansf�:aion. '(h�f 1 arn r�u!ho�rzeu L�y fne ov��ra=,•' of dhis pro�;�rty to �cr;crrn fhe :voik ior v,•�+ici� a;�p.�?ca:ton rs ���ade ar,d I
<br />corT�oty 4rr?h ihe Sfate Gaotrsc!c�rs La�v� 9&`. �7 t�C!N ar,� �'96 ?00 �-VAG.
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