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GITY OF EVERETT <br />Snohomish County, Washington <br />UNSAFti' I3UILDINGS <br />STAT� OF IYASI3ING'fUN ) SS <br />COUN7'1' Ol 5NOIi0I�1ISH ) <br />FORM G <br />�� i �� � <br />R�FER7;'NCE NO. ��- � -, <br />AFI'IDA,VIT Or SL• RVICE <br />The undcrsigncd, bcing first duly sworn on oath, deposes and says: <br />1, That in and during all Ciines herein �nentioned, affiant was and no�v <br />is ovcr the age of Ywenty-one years, a citizen of the United States, a resident <br />of the Statc vf Washington and competent to Ue a witness herein, <br />2. ThaC afliant scrved a full, true; correct duplicate original copy <br />of ihe following der.criUed docuinent: (Cross out ivapplicable noficcs) <br />(a)---IV01'I-EE OI' UNSAF'�-I3UILDINC>(S3 <br />(U) IQO'PICT� OF PRP�SF..N'I"A?'IO�` OI' 73IIILT'F_I�`G <br />OFPICIAL R�QUI:ST 'I'O CI1'Y COL'NGIL P'OR <br />AI�� ORD�12 <br />(c�—�'O'�IG�'�O�{'I1'Y (;OIJ?�.GiL ORI�ER <br />Ownrr Namc <br />A copy of �vl�ich is attached Uereto and by this referencc <br />made a part hcrcin as tl:ougl� set Corlh in fiill hereiri <br />upon cach of Y1�c following last ]cvotvn owrer(s) of <br />rocord of tlse building(s), or sfrucl�irc(s)� or portion(s) <br />t:hercof descriUed in said documenL Uy the meinner set <br />furth hcrci.�tZftcr: <br />(a) P�RSONt�L SLRVIC:Ii <br />13y delivering and ]eaviiig said copy with said owner(s} <br />at thc place and tiine seC fo:Cli hereinbelo�v: <br />Address Scrved <br />Datie Scrved <br />•, <br />