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<br /> _,s. 3200 C�DAR S-]-R1=ET, �V�R�TT, WA 98201
<br /> {P) 425-2�7-8810 � FAX 425-257-8857 ] (E) everetteps@everett�a.gov j www.everetfwa.gou/permits
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<br /> PROJECT AQDRESS: � _ �^- �"G�' � ^C�.
<br /> BllILDII�G AREA(if residential, new construction, remodel, or addifio�) S�
<br /> BUILD[NG TYPE: ❑ SFR-DE"(ACHED ❑SFR�TfACHED Cl DUPI_EX L MULTI-1=AMILY-#OF UN1TS: I� COMMERCIAL
<br /> USE OF BUILDII�G: '
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<br /> , < I�E��c��'N��c��G �I���Qc�l�ll V��1 fl9�IlF��iN1�'�'q�8�1
<br /> COMTRACT PRIC� OF WORK:�
<br /> NUMBER OF DEVICES (if low volfiage); �
<br /> FIRE ALARM? ❑YES ❑ AIO
<br /> ASSOGIATED BllILDING PERN117#(if applicable):
<br /> DESGRIPTION 0�'WORK: cJ ., <>C P/ �
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<br /> . _ " �: - CO�TACT 1I�F RMA. !, N :
<br /> QiNNER NAME_=. . . • • TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srrzeEr
<br /> .. . . C� ._ . � . _ . � .. � . .. STAl'E ZIP
<br /> OWNER PHONE: DWNER EMAIL:
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<br /> CONTRACTO}�NAME: FJ���X� a�i,L l� -
<br /> CONTRACTOR ADDRESS: sTREET U� r r �
<br /> / ��J. � � CITY �� STA7'E 7JP � C
<br /> CONTRACTOR PHONE:� y—,�CJ� � ?J I GONTRACTOR EMAIL: ��
<br /> CONTRAC70R LIC.#(RE[�UIRED): CITY OF EVER�7'T SUSWESS LIC.#(REQUIRED}:
<br /> PRIMARY CONTACT.Y ❑ OWNER ��CONTRACTOR ❑OTN�R(Please Specify)
<br /> CaNTAC7'NAME: GONTACT PHQiVE: -"�J f— �'�
<br /> Gj(:-�i�Ci� l�i'G�V CONTAGT EIYtA1L:
<br /> AGREEMENT.�T he�eby ce�tify thaf I have read and axamined this application and know tha same to be true and correct, AI!provisions of laws and ordinances goveming this
<br /> fype of work wi/1 be comp/eted whether speciFed herein ornot The granting of a permit does nof presume to give authority to violate or cancel the provisions of any other state or
<br /> locallawregulating constructlon orthe performance of consfn�ction. Thaf!am authorized by the owne�oi this properfy to perr`orm the work forwhich application is made and I
<br /> cornply vrith the S�ate Confractors 1_aw 9d.7.7RCW and?_96.200 WAC.
<br /> Cify of Evereff O�cial Use Only
<br /> FEE
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<br /> OvvnerlAufiiorized Agenf Signafure �te (Revised 10%f212(J95)
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