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� �������ac�a� p������� a� ��,��i����o�
<br /> �� -- _
<br /> �s �,���_ C1TY OF EVEREI T PCRMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, VI�A 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettvl�a.gov/permits
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<br /> PROJECT ADDRESS: � � ' . �t, ^ C;=-� r �� .
<br /> BUILDING AREA(if residential,new construciion, remodel, or addition) _ SF
<br /> BUILDING TYPE: ❑SFR-DETACI-1ED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MLILTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING: � � ___
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<br /> CORITR,4CT PRICE OF 1NORK: ' ��C-:� ,f
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<br /> iVU(1(1BER OF DEVICES (ifi lo voltage): ''
<br /> F1RE ALARM? ❑YE O
<br /> ASSOCI�,TED BUILDI�IG PERMlT#(if applicable):
<br /> DESCRIPTfOhI OF 111/0R : � �v� �� — (�.1 "' �� �
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<br /> - ��F��f'�a��° �N����A'fi'1!�?<4 - -
<br /> OWNER NAME: TENANT PdAME(!f Commercia!):
<br /> OWNER MAILING ADDRESS: sTREEr
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<br /> OWNER PHONE: OVYNER EMAfL:
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<br /> CONTRAC7DR NAME: ��„ -,1• >
<br /> CONTRACTOR ADDRESS: s-rReEr -
<br /> CITY v��.l STA7E �,� ZIP . ? '
<br /> CONTRACTOR PHONE: -- 3 " CONTRACTOR EMAIL: LiJ� S�'��L �I ec,N�.\ �L-��� . C��
<br /> CONTRACTOR L[C.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �
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<br /> PRIiV1ARY COIVTACT: ❑OWNER NTRACTOR ❑OTHER(Please Specify)
<br /> COhITACT NAM�: CONTACT PHONE: l��'�— �3 � " ?��`3�
<br /> < � ��y,�Q CONTACT EIllIAIL: • S�L-�
<br /> AGREEMENT.-T hereby cerify that I have read and examined ihis application and knov✓ihe same to be true and correct. All provisions oflav✓s and ordinances goveming this
<br /> type of work ivill be completed whe(her specified herein or not. The granfing of a permit does not presume to give aufhorify to violate or cancel the provisions of any otherstate or
<br /> local!aw regulating construction or fhe performance of construction. That l am author'rced by ihe owner of this properfy to perform fhe work ior which application is made and l
<br /> comply with the Sfate Coniractors Lav✓98.27 RCW and 296200 WAG.
<br /> ' Cify of Evereit Offfcial Use Only
<br /> FEE
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<br /> � PERMIT
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<br /> Owne ized Agenf Sign ure Date (Revised 10/l2/2095)
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