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<br /> C1TY OF EVERETT PERMIT S�RVICES
<br /> 320Q C�DAR STREET, EVER�TT, WA 98209
<br /> (P)425-257-88'i 0 � FAX 42�257-ass7 f (E) everetteps@ever�ttwa.gov� www.everetfwa.govlpermits
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<br /> PROJECT Al]AIt�SS:
<br /> BU[LC?ING AREA{if rasidential,new consfructton,re de1,or addf8on) SF '
<br /> BU[LDING TYP�: �l SFR I]ETACHED ❑SFF2 ATTAChIED CI DUPI.EX CI lVIU1.71-�AMlLY-#O�UNITS; �COMNhE�tG1AL
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<br /> LM. :�Lt'r �i£'..43.. ;�.!�•:i:::
<br /> CpNTRA,CT PRtCE OF WORfC:$ fj •
<br /> NUMBER Q�D�1l3CES ifi low voltage:�
<br /> FIR�ALARM? ❑Y�S NO
<br /> ASSQCIATED BUILDINC PERMIT# !f a piicable:
<br /> DESGR1p7[O[�i OF WORK:
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<br /> OWNER NA�IfE: � TENANT'NAII��(ff Commerctag: � (�
<br /> QW�f�R MAELfN�ADDRE55. srReEr �x �j �
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<br /> OWNER PHONE: OWNER EMAIL:
<br /> COiVTFiACTO.F2 NAM�: � / �t..,�
<br /> CONTRACTORADDRESS: srne�r PQ �D�(
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<br /> CONTi�ACTOR PHONE: ",� '7�"� `t' CQN7'RACTOR ENlA11.: /�f, /,�`1�r,� / / , (,�D�
<br /> CON7RACTOR UC.#(RE4UIRED): L��N�� �D,z CITY�F EVER�TT�t1SINESS LIG,#{R�QUIRED):Q�DS
<br /> PRINlARY C�NTACT: ❑OWNE}2 G.�CONTRAGTQR ❑OTHER(Piease Speclfy} •
<br /> CONTACTNAM�: GONTACTPI-iONE: Z�-"73(�-��5��
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<br /> AGR�MENT.�T hereby certffy that 1 have read and examined thls appllcetlon and Imowihe same to be bue and correct AU pmvislons nflatv,s and ordlnances governing this
<br /> fyps of wnrk wUl be completed whather specif/ed herein nrno� The granUog of a psrmJf does nof presume to glve authori[y to vfolate or cancel fhe provlsfons of any ofher staFe or
<br /> lacailaw regulatFng constructJon orthe pefformance of consfructlon. 77taf 1 am aulhorized by fhe owner of this pmperfy to perfarm ths work for svhkh appllcatlon Is nrade and!
<br /> compiy tvith ihe Sfate Gbnfracfors Law'18.27 RCYY an.d 29&2[Jl1 WAC.
<br /> Ci{y of Evereft Official Use OnJy
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<br /> OwnerlAu or zed Agen Slgnature Date (Revfsed 10/?2l20i5)
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