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1EEP.1-REEECTMAL PERMOT APP*UCAT MN <br /> CITY OF EVEREIT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE!1, WA 98201 <br /> (P)425-2-57-8810 ( FAX 425-257-8857 e-vererieps ca ever9Uvja.gav ( jkqfijwever9Uwa.gov/permfts <br /> l PU10JECT SETS ONFORIWA70GR5 <br /> s <br /> EllLI�INC APPA(if rsWdent'sat,nQw eons*ucgon,remodel,or x�dd{notz? SP <br /> fiulLnlntc TYPE �St=R-DETACHED II SFR ATTACHED II Dt1pLEC II MULTI-FAMILY-#OF UNI T S= IItMi�1tERCtAi <br /> tUSE OF SUIL DING: <br /> JCONTRC T ; iC� 1F1f� € : "2 C`, c>C <br /> NUM-UR OF DEVICES(if 10vuv0tt29e)_ t <br /> F1 RE ALARM? M YES E3 No <br /> ASEOGIA T D BUILOJINC PERMIT#0f applicable): ------ <br /> y-V 1 .. <br /> {� f <br /> t <br /> Ct}rfl7imF�11 iUIE: F ti- -N-M ,i1T NAME(1f Commercial): {1 <br /> i <br /> 4W1lER MAILLNGADDRESS: SmEur <br /> li <br /> G. C[SY <br /> STATE rJP <br /> t <br /> ©lil(nICPs F3C1111E: �f3llil�"s�EMf3tL; <br /> eORI T 1CTOi 11lAME: C—,► <br /> a <br /> GON T RA Cs OR ADOPaSs: S;REE-11 <br /> �y <br /> cry -i�'�il�'v�,✓:� � srnM <br /> i'GORTRACTOR PHONE: Lc (o S 3 9 Lt.3 1CONTRACTOR ENdA3L- CL-n,.nd CL G A�C,rv. t nY• C..-_',,n <br /> LIC. � 6; t G,T [;lTyCF EVE�BUSUIESS Lie g(RECUlREo):COTRAGTQ I+ <br /> PRIMARY- CONTACT- <br /> 01NT,AG t_ C1 OWNER <br /> ' CONTRACTOR LI OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT Po. E: ,tet.G5 3 Ct�t 35 <br /> AGSFEi rW&ti-T hereby cer*that i have read and eranured this appfi-§0a and 107OW the same io die tma and cafteaL rill prole guns or taws and ardwrantres ggYEtMg Mis <br /> type of word' "Q be co,repleted whamerspacltied hemir,oraot Tree granting of a permti does not presume fo give 2uthotify fo violate orcanca!the previsions taiany afherstate crr <br /> focal 12i:r�guk'ting canstructian orihe performance a€consttuetion. Treat!am authorized by fhe owneror"this properly is penbrm the work Tar s°rhich spwrim on is made and! <br /> aorrply t:Iirh the Mete Contractors Lain 18"23 PCW and 29&.2oo WAC. <br /> city of Eva mfi Ofciat llsa f WAW <br /> I�FEE <br /> IE <br /> r�7 00 <br /> �{ PERM[4J/L'f— <br /> RE <br /> OwnerfAuthorizeii agent Signature <br /> Date (Revised 1(tIIW61) <br />