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<br /> C1TY O��VERETF PERMIT S�RVIG�S
<br /> 3200 C�DAR S7'R��T, �1l�R�TT,WA 982�9
<br /> (P)A�2�-257-88'I O � FAX 42�257-8857 � (E) everetteps@evereEtwa_gov j vaww.everefifwa.govlpermits
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<br /> PROJ�cT Anpl�ss: �
<br /> BUILDING AREA(if residen#ial,new consfrucUon,remod I,or addlfion) SR '
<br /> BUtLbiNG TYp�; C!SFR DETACHED l�SFR ATfACH�l7 Cl DUPL�X CI MUl.Tl-�AMl1.Y-#�F UN["fS: �COMMERCIAL
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<br /> � FIi�E ALAR,M? 17 YES NCl �
<br /> ASSOGIAT�D 8UlLD1NG PERMiT#(if a licable}:
<br /> D�SCWpTION OF WORK: j
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<br /> OWNER NAM�: � TENANT 1VAM� If Commercial: �p
<br /> � OWNERMAI�.INGA�DRESS: sra�r �JX 3 �
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<br /> OWI�ER PHONE: • OWN�R�INAIL;
<br /> CON7RACTOR.NAIVE�: + G1 /v
<br /> CONTRAGTORADARESS: sra�r PO �OX
<br /> C[TY I4. 37A7E�i 1 ItP GL/
<br /> �ONTRACTOR PHOtJE: �j'Z �' �t'"y" CON1'RACTOR EMAIL: f. IY1��,Ie l / � CD�
<br /> CON7RACT0121.iC,#(REQUfRED): (��N� -T�z C1TY O��V�t2�71'BUSILV�SS L(C,#(REQUfR�D};Q�D
<br /> PRIMAI2Y CONT'AG'I'; ❑OWNER 6�I CONTRACTOR ❑Ol`HER(Please Specifyj •
<br /> CdIVTACT NAM�: CdNTACTPHONE: ��.736"�QS��
<br /> • 1��'!�N 1 S L��.D{�/ CONTACT EMAI�.: p���t�.L'KO�.tI 0 �lE"WlT. �.olY!
<br /> AQl�ENr�NT,•T hereDy ce�fity ihat!have read and exeminad fhls applicafion and know tha same to ba true and carrect A!1 provlslons oflasv.s and ordfnances governing thfs
<br /> type of wnrk wl!!be'completed whether specli7ed hereM ornot 7he granifng ofa permit does not presuma to give aufhorqyfo vfolate or cance!the p�ovlslons of any ofhersiate or
<br /> lacal!aw reguladng constructlon or ths perforrnsnae of aonstrrrcUon. That!am authorized by ihe o�vnerofthls property(o perform tha work for whldt apgCrcaflon is mads and I
<br /> camply wlth the State confractors Law 98.27 RCW and 296.2od WAC.
<br /> Cl�y ofEvere#Officlel Use Otrly
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<br /> PERMiT�
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<br /> OwnsrlAa or zed Agent S(gnafure Oafe � (Revlsed�0/92/2U95)
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