|
� fOZ925-loD/S:G�/ ��O
<br /> � .. .
<br /> . �����1�.��A� ����1��T �,P�����'����I .
<br /> C1TY OF EV�RETT P�RMIT S�RVICES
<br /> 3200 C�DRR STR��T, �V�R�7T, WA 98209
<br /> (P}�2�257-8810 � FAX 42�-257-8857 ( (E)everetteps@evereftwa.gov j vuvuw.everefitwa.gnv/permits
<br /> _ c�s•. ��;. :{'. i4: :;'s';.�;.iy� . ..}. ,:4. _ �.•+w�v.,�t... .S� .t... .:r;•i..ns y...t.,^.,.`,,.V,..`�..
<br /> ,,; -;�,i�: '•�: O:D�G'. .,5�.. ';O TIO� •��
<br /> -�'� _'� `�'.,.,:A��..�.��. - �r���
<br /> .3�. - �1' +F�`."
<br /> i:i� ';i:. ..9,:'�,.e.., ..'r' .ns..: c.a.NawR--�.F.- e,. •:r..�.w�.v.�n. ..�•s-...:..�.,..�s:.:•�[•.',�,'• i,•� w
<br /> PROdEC�'ADI�R�SS: �� ;
<br /> �UIl.D1�IG Al2EA(1f tesidsn#ial,new constructton,remod 1,ar�ddltion) SF ' '
<br /> BUILbtNG TYpE: CJ SFR DETACNED ❑SFR ATfACHED ❑DUPL�X I�NIUL,71-�AM1tY-#OF UN17S; �CQMMERCIAL
<br /> USE OF BUILDING: OE G �VG'��c TT' •
<br /> u.; i+�4��siq�'��•:,3y1�.M��.• ;.�:�,.t'�.��rf,'......Isu.m v�.�:r.y / .nw�..r`.•i. e.f...�.a.�. ..te.y'r•r•..rvr.::� i:�i'yi:�^'�;',.'f.rs^,ij:.jey,T';;l•i -�.��r� • .
<br /> ,��:.�r;.�. :;F ..,:; � - . .�L �r t Af;"a1���i�i�.�.,.�,�o �j� o�r�AT��oi����� �.�: ��� �:_:.:��:;. ;
<br /> ::��rw :�t1:�s: :..1:. `.�:k`...y c[.t�iin.nT���:S•:4r. �.[. :•r'••I;�Y.Ry.^�A�;�T�:�....'4:�«!Y �..t�•�S�ixi���..hu•�..J:ry.a.•. .-�t4'n:•f:i:�1:��'i�'.��i:r.1:::�.u.t.�H'�.�5-.:���;i�:.l��'. .
<br /> CbNT1�ACT Pl�IC�OF WORK:$ �
<br /> NUMB�R OF D�VICES(!fi low volta e:�
<br /> ' �IE2E AL.A.RM? ❑Y�S NC3
<br /> ASSOGIATED BUILDING PERMIT# if a liaabis):
<br /> DESCRfPT[ON OF WORK:
<br /> ..- .
<br /> :{:�:1 -� • • � • • � --•�•. .. • . . ..�, ,. .. , ,. . , .,.... �<: , -.- .,
<br /> . .;_ _� ' • ;� MCOI�T�k#CT.'1N�0��1T�ON - :>
<br /> OWAl�tt NAME; � TENANT NAM� If Commerclat : �L��,�
<br /> • OWN�R MAE�.fNGAl7Dl�SS; s���r �X �j �
<br /> �►� �- �A�1�►/r4 L lz -zza7
<br /> OWNER PHON�: OWNER HMAI�.:
<br /> CONTRACT�.R NANf�: Gl / /C.�
<br /> CONTRAC'tOE2 ADDR�SS: sTR�r PO LJD�C
<br /> cny /� /L L.� sraT�� vP ZD . . ,
<br /> CONTRACTOI�PHONE: rj-"2 7'" �t' CONTRACTOREMAIL: /�` f, /���� / I � C��}
<br /> COiVTRACTQR L[C.#(FtEQUIRED: G�N� �Dz CITY O��V�12E'TT�USIt�IESS L1C.��REGiU1R�D: LJ
<br /> FRIi�IARY CONTACT: p pWNLR $a CONTRACTOR CI QTHER(Please Specify} •
<br /> CONTAGT NAME: CONTACT AHONB: �f,,�(p-73 b"'tp,r'7��
<br /> . ��f 1�1�j�J ��� CONTACT�MA1L: (���f�j�j'.�I�O�� h j�Ul/�l T. �O�
<br /> AGRF�M�NT.•7'hereby cerU/y fhat/hava read and exam/ned fhls applketJnn and knnwthe sama to 6e Uue and correct AlJprovisfans oflntv.s and adinences gaverning fhts
<br /> type of work wJl1 be'completed whetherspeclfied herein ornof. 77te granfing of a permR does rtat presume to grve authorllyto vlola[e or aancel the provlstons of any ather�atate or
<br /> locallaw regulatJng consfructlon or fhe perfvrmanca ofconstructiota That!am authorrzed by the owner ofthis proparty to perform fhe work fo1�whlch appticatlon Is made and!
<br /> comply w!!h the Sfate contractors Law 9&.27 J�CW and 29e 2od WAC.
<br /> Cify of Evereft Olflcla!Use Only
<br /> F��� �
<br /> ��� �
<br /> y c.
<br /> P�RMIT�
<br /> • � a�� � �� � o � ��
<br /> �
<br /> Owner u or zed A enl Slgnature Date (Rev/sed 70/�2l2096} '
<br />
|