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���������,� ����0� ��������� <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EV�RETT, WA 98201 <br /> (P)425-257-889 0 � FAX 42�-257-8857 � (E) everetteps@everettwa.gov � www.evereftwa.gov/permits <br /> . . : , , ... <br /> - <br /> .. <br /> � ��o���� ���� a�������a�� <br /> ,. -.: _:_ . . .. .... � . .._ . ... <br /> /? - — A,� i,t, �. <br /> PROJECTADDRESS: �LV � C � ��2. /�( ' <br /> BUlLb1NG AREA(if residential, new construction, remodel, or addition) S�' <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCfAL <br /> i <br /> USE OF BUILDING: C_UW( ' �;Si �C S S <br /> ,. : _. _ _ _ <br /> _ . _ _ . _ <br /> ���c�r�aec��. a�������-��oea ��������ao� <br /> CONTRACT ARICE OF WORK:$ '" , • � � <br /> (VUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,.______ — ___ --- <br /> DESCRIPTI�N OF WORK: �--��- � <br /> �/l� � X 3 � 1 , '�-, �o � � ' �--�-, � o�,��,,� <br /> , , ,, ; . , . : _ -� _, .. _ _ _ <br /> ; <br /> ' GONTACT:INFORMATION : - `-. � - <br /> __ _: _ _ __ _ __ . <br /> OWNER NAME: �ver� o ' '�' � -l�L C TENANT NAME(If Commercial): c C—� <br /> OWNER MAILING ADDRESS: srREEr ��2�� �� �V��� �• l � � <br /> L� � <br /> CITY C�"en�� " STATE "" � 7JP �G <br /> OWNER PHONE: OWNER EMAIL: <br /> . ._....._.._ _ . <br /> ., .......,... ,�..____ ..�.�.. �.__.__/_.. ._, ....,_.�._ �:..� __ �,__:. . .. ,�_. � ,..�,_:..�........ <br /> CONTRACTORNAME: /�G( ,� �-c�/ S�'� � � ln�f!'�� <br /> CONTRACTOR ADDRESS; l STREET 3� t� �f vV �� <br /> CITY U / STAI'E ��� ZIP /��/� <br /> CONTRACTOR PHONE: Z�2'��7�7' ��I � <br /> CONTRACTOR EMAIL: , �i Cc./� �I bO , �'ryi ' _ C <br /> GONTRACTOR LIC.#(REQUIRED): 1*I����/U�L��13 l�f� CITY OF EVERETT SUSINESS LIC.#(REQuiRE�): h�-6 3>�y7 <br /> PRIMARY CONTACT. N L7 OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '�5�— "f�- rJ-�j Q `3 <br /> K�c./i^/1 �J'"J CONTAGT EMAIL: C ,S� ., �/� ,�� � !'Lti, ; lc�'-� <br /> AGREE�ENT.'T hereby cerfify that(have read and examined this application and knovr fhe same to be frue and correct All provrsions of laws and ordinances goveming this <br /> type of work wif!6e completed whether specified herein or not. The granting of a permit does not presume to give authorify to violate or cancel the provisions of any ofher state or <br /> loca!lawregulating construction orthe performance of construction Thaf 1 am authorized by the owner of this properfy to perform the v,�ork for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> Cify of Everetf O�cial Use Only <br /> FEE <br /> � �� �� <br /> �-7 .� PERMIT# <br /> 1 r� .� ,� �%�3� � � � � <br /> � <br /> � o� <br /> Ownef/Aufhorized Agent Signafure Date (Revised 10/12/2095) <br />