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CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE IMFORMATIOnI` <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> �;TRIt ATIIOM RMFORMATION <br /> CONTRACT PRICE OF W RK:$ <br /> NUMBER OF DEVICES(if low voltage : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicablej. �-- <br /> DESCRIPTION OF WORK: SE <br /> - l� - ADI <br /> CONTACT INFORMATION.Pi <br /> :. <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STV - <br /> i� . <br /> cr STATE - <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET ' ., <br /> CITY fill STATE ZIP <br /> CONTRACTOR PHONE: 3 -] CONTRACTOR EMAIL j-,V�L,/U11' <br /> -fi <br /> CONTRACTOR LIC.#(REQUIRED): ` CITY OF EVERETT BUSINESS LI #(REQU ED): <br /> PRIMARY CONTACT: El OWNER '.CONTRACTOR �QTHER(Please Specify) Ji rY. <br /> CONTACT NAME CONTACT PHONE: ��� S <br /> CONTACT EMAIL: _Cpw. <br /> AGREEMENT.Thereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# q <br /> :?\3 E c C CD/ <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />