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<br /> C1TY O��V�RE�'T PERMfT S�RVIC�S
<br /> 3200 G�QAR STR�ET, EV�R�TT,WA 982D9
<br /> (P}425-257-8810 J FAX 425 2�7-8857 � (E)everett�ps@everettwa_gov� www.evere�t�nia.gov/permits
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<br /> BUIL.DIHG AR�A{if residentfal,new constructian,retnad I,or addlfian) SF ' ,
<br /> BUlLDiNG'1'�YPE: CI SFR DETACH�p C)SFR ATf'ACHEb Cl DUPL�X CI MUL.'I'I-�AMl1.Y-#�F UNCCS: �COMl111ERCIAL
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<br /> CQNi"RACT PRIC�OF WORK.$ •
<br /> iVUM��R OF D�VICES(If low voita e):�
<br /> � F1RE ALARM2 C7 Y�S N�
<br /> ASSOGIAT�D��1JLpINC P�RMIT# if a plicable:
<br /> �?�SCE2IPTION 01�WORK:
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<br /> OVYN�R NAME: � 7�NAIVT NAM�(1F Comrnercial; �L� lg
<br /> • OWNERMAI�.INGADDR�SS: srnEEr �OX 3 �
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<br /> OWNEtt PMONE: • QWNER.EMA{L;
<br /> C�RITt�ACTO•R NAM�: C1 /t.�
<br /> CONTRAC7QRA�DFtESS; s7rcet�' PO �D�C
<br /> C[fY I� G.� STAT�� TIP
<br /> CONTRACT012PHOtJ�: 5�Z �- � GONTRAC7dR�MAl1.: ,q-�1. /I'��r,� ! , L'D/1')
<br /> COlVTRAC70R LIC.#REQUERED: ��N� C `7'Q z CITY O�EVERETT gUSIN�SS LIC,�(REc1U1RED}: �
<br /> PRI]�IARY CONTACT: CI OWNEI� k�VCONTRACTOR ❑qTHER(Please Spectfyj •
<br /> CON7ACTNAM�: CaNTACTPHONE: Z�-736"'�pS�lp
<br /> . ��'1+JN I S L��.d�l CONTACT�MAIL.: a�N�tS.L'K�OI.tJ 4 kl�'vv'!T. C�.otY�
<br /> AGF7EENI�NT•7 hereby certiry thaf J have read end examined thls applkaHon and knowths same to bs true and cnrreaf. A!!provisfons oflaw.s and ardlnences governing thts
<br /> lype of work w!!l ba`complefed whefherspeclfied bereln or nof. The gran8ng ora permit does not presume to give authorKy ta v1olete or cartce!the pmvls�ons of�ny other slate or
<br /> local!aw regulaling conshucttan or tha performanos af constructlon, That!am authorized by tha ownarofihls properly to perform the work for whlah applicailan fs made and i
<br /> camply wilh ths Stafe Confrac�ors�aw��27 RC W aad 29B.2U0 WqC.
<br /> City ofEvemft O�clal Use Only
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<br /> P�RMIT#
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<br /> ownerAu orzedA an Signature bate {Ravised?0/92/2016)
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