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<br /> C}TY�F�V�R�7T P�RMET SERVtC�S
<br /> 3200 CEbAR S�'R��T, �VERETT,WA 9820'�
<br /> (P)�25�257-88'!� J FAK 425 257-8857 � (E)everetteps@evereftwa.gav j vvww.everettwa.govJpermits
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<br /> BUILDING AREA(if residen#iaf,new construction,rem el,or addifion) SF '
<br /> Bl111.DIN�TYPE: Cl SFR pE7ACHED ❑SFR ATT'ACNEd f�DUPLEX CI MUL71-�'AiUifLY-#OF UNETS: �COMMERClAI,
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<br /> CONTRAC7"PRIC�'Ofi WORK:$ .3 •
<br /> NUMBER OF D�V(C�S if low volta a:•
<br /> FIR.�ALARM2 ❑YES MO
<br /> ASSOGIATLD�l3tLDING P�RM1T#(if a (icable :
<br /> D�SCRtPT1�N O�WORK:
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<br /> OW1V�R IVACI+IE: TENANT NAM� If Commerciaf: �j
<br /> OWNER MAILING ADDRPSS: s-r�eEr �C7x �j �
<br /> ClN �r STAI'E ��/� Z�I� !Z "GZv�
<br /> OWNER PMaNE: OYVNER EMAIL:
<br /> C0117RACTOR.NAME: � G� /L.�
<br /> CQNTRACTQ}�ADD�iESS: srRE�r /`G� �DX
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<br /> CON7RACTDR PHOiVE: �j' 'Z �'"� `7'� C�NI7RAGTOR�MA[L: /Q'/�I. �J�r1� I � CD�}
<br /> CqNTF2AC'1'012 L.IC.�#(REQUIR��J: ��N�I�.� '7�D Z CI'CY O�EVEI�T'1'BUSIAlESS LtC.�#REQUERED; U
<br /> PRiMARY CON7ACT'; I]OWNER, B,!CONTRACTOI� CI OTHER(Please Specify) �
<br /> COtJTACT NANIE: CQNTAGT Pt-iONE: ���'73�-�Cp 5Ljt.Cp
<br /> . �j�N r�r 5 C�.d�nl coNrac�r��ra��: p,���t S.�.Kd�tJ D l�1�"vv`t T. L.ofYl
<br /> AGl4�&MENT.•7hereby certify that!lrave read and examJned this appFrcafion and lmow ihe sams to be true and corrsck .411 provisions oflaw.s and ordlnancas goveming thls
<br /> type of work wldbe complefed rvhefherspec/fied herein or noG Tha granting vf a permll does not presume fo give authodly fo Wolate or cance!fha prov/slons of any ofhar sfats or
<br /> /ocallaw rsgulating constrtrction or the performance of cons[ructlon. Thaf 1 am autltorized by the owner c�'ihTs property to perf'orm fhe work for wh1cL appllcatian is made and!
<br /> comply wlth tha Sfafe Contractors Law 98.z7 RC W and 298.2oa YVAC.
<br /> City of,E'veretf Officfal Use Only
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<br /> P�RMIT#
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<br /> Owner Au orized Agen Signafure pate (Revised 90/�2/2015)
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