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<br /> C1TY OF EVERETT PERM1 i
<br /> a�=�� 3200 G�DAR STR�ET, �1/�R�TT, INA 98201
<br /> (P) 42��257-8810 � FAX 425-2�7-8857 ] (�) evereft�ps@everefiv�ra.gov� wtrvv,t.evere�twa.gov/permits
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<br /> PRQ.]�CTADDFt�SS: ���� 1,J ..:Z����. ���,P��.-t—'-� W�- ��°�� e
<br /> SUI�.DIIUG AREA(if residential, new consfruction,remodel, or addition) � �� � ��
<br /> SUILI]ING TYPE: �SFR-D�T/aCHED Q SFRATTACHED Ll DUPL�X CI MUI.TI-FAMILY-#OF UNITS: I7 COMMERCfAL
<br /> USE OF BUILDIPIG: � —
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<br /> coN'Tt�AcT PRIc� oF WORK:� `-
<br /> NUMBEI�U�'DEViGE� (if low vo]fiage); �
<br /> FIRE�I�IRlVI? ❑Y�S �o
<br /> ASSOCIATED BUILDING PERNII7#(if applicable): � ��� � T �`� 1
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<br /> DESCRIP7ION OF WO}�K:
<br /> �P�L� �✓',z� ���e✓' �� -�- .
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<br /> -- . . . COI�T:�;CT�IAIFORIVIATION�. _ - _ - - _--- -
<br /> (]3NN�R NAM�:_=� �'�gf�'( �J�UIUI��A1(�l��S S!��C.�J T�NANT NAM�(ff Commercial): —
<br /> OWNER MAILING ADDRESS: s�zeEr I V�Z �T� I � �
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<br /> OWNER.PHflNE: �Z`� - !�'Z^ �`� �� oWNER�MAit: CR�D�.c�Sa�?(�•. I-����rk•i S�1,��{�n.tl s I-��v�� .
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<br /> CONTRACTOR ADDRESS: srREsr ��w�--� � 5 ��`�✓
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<br /> CONTRACTOR PHOI�T�: S H�•r CDNTRAG70R�MAtL: � s'��"'"�
<br /> Cpj�l'I']�,4CTOf2 llC.#(REQUIRED): CITY OP EVERETT BUSINESS LIG,#(REQUIRED):
<br /> pF2]MpRYyCONTAC7'.rt C7 OWNER �'1�CON7RACTOR �(O�HER(Please Specify)
<br /> CQNTAGT 1VAME: GONTACT PHO�tE: 2 S �Z Z Z✓!n�
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<br /> AGREENIENT.'T hereby cerfify that 1 have read and examined this appGcation and know the same f�be true and correct. All proyisions oflaws and ordinances govem?ng this
<br /> iype of work wil/be complefed whetherspecified herein ornof The granting of a permit doas noi preaume to give aufhorify to violate or cancel fhe provisions of any otherstafe ot
<br /> locallav✓regulating construcffon orthe perfarmance of construction. That/am authorized byihe ov✓ne�oifhis properfyto perforrn the v�rork forwhich application is made and 1
<br /> complyv✓ith the State Cont�actors Law�8.27RCWand 296200 WAC.
<br /> CityofFvereff Official Use Only
<br /> FEE
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<br /> PERMIT#
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<br /> Ovv utliorized Agenf. ignafure ate (Revised�0/12/2095)
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