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�_y�.�`i�9C�� ��!��'��0`�' ���aS����AT'��� <br /> ,��- CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � wwvv.everettwa.gov/permits <br /> �_�_::-�� ���_.�u�.��-._.,,a.��.� -�,.�, <br /> � u��C����� �G`�'� G�C�G�b�������G:.n <br /> PROJECl'lADCRESS: ' 1 Z ��C- <c �^���S JY�P., ��``''t" `c,�lc v'e L � �.:%�'=} �=j Z;2�.,`( <br /> BUILDIP[G ARER,(if residential, new construction. remodel, or addition) �F <br /> BUILDING l'YPE: ❑ SFR-DETACHED ❑ SFR-ATTACHLD ❑ DUPLEX ❑ IVIULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: ��l� L�'� <br /> . _._- :_:_-_. ,�_y_.:�..�._.__.._.__�.��,. .�,a.�.,_o,��.-.m„=,-. <br /> _ �_.:.,-,�.�-,�..:,,�� .,wb..�.:�,�..._..�,.. ��_...:_. 1.._.:�_.��._:.._ _ . <br /> � ���� ������ ����.a���a�c� o�����,���°o�c,� <br /> �� <br /> ��rd��rac�� ►�uic� c�vvo�. : �Io��� <br /> NUMBER OF DEVICES (if low oltage): <br /> FIFZE ALAi�M? ❑ YES t�0 <br /> ASSOCIATED �111LD1�!� PER�ViBT#(if applicable): <br /> DESCRIPTIOPv OF�,�/Or��:: ���5�' ���Iti`C'��; '�c. (-Y-� US' � i,�'fi I�� j�vLC�f—' <br /> � ����-��� E�������m�c� - <br /> �OEOJ��E��REAfVIE: �. <br /> LkL�- G'L � L? TEPd,a,NT NAM�(If Commercial): <br /> OWNER MAILING ADDRESS: sTher-r ��Z()D �J ?✓ "Y�-/1 w` <br /> rITY `(�l.�y'-✓��'�C�l... � SrATG �, ZIP C' V� )G <br /> OWNER PHONE: ?�'� �Z � �C�Q OWNER EMAEL: <br /> CONTR�CTOR NAIViE: �r1Q , '' �vIL'Gln' c�OtitM`�F' (!�1� <br /> CONTRl�CTOR ADDRES�: srt;rr.T / (�O� ��yt� ' ��,J �(� <br /> cnv �., i-J C(iia srArF ��'{- ZiP �p' p (`� <br /> GO�!TR,4CTOR PFlOiLE:�ZS— — S—�; CONTRACTOR EMAIL: C7��X � �l�1 S 1 ��'�� ° �C•� —�`���"� <br /> CQNTR�-!C�TOR LlC.#(REQUIRED): �(all �, ' ���l'� 3 CITY OF EVEI2�TT�l1S9iUE�S L.C.#r(REQL�fZ�ED) <br /> PRIiVIARY CONTACT: ❑ OWNER ��CONTRACTOR ❑ OTHER(Please Specify) _ ____- —_ <br /> CONTACT Ni�hAE: CO�V7ACT�FiOCd�: �Z'� — '�y J " 3 5 Z L. <br /> ��,.�c ��t Ci C�� COIVTP-1CT�iVi�IL: Gt'f.f' �( � L/J��/ �LZ : � [�lM <br /> AGREEPAENT:T hereby certify thaf I have iead and examined this application and I<now the same to be irue and correct. /111 provisions of laws ar,d ordinances governing this <br /> type oi work wil!be completed wl iether specified heiein or not. The grarrting of a perrnit does not presurne(o give authorify to violate or c�ncel ttie provisions of any other state or <br /> locat law re�idating construction or the per`ormance of construction. That 1 am authorized by the owner of this property to perform the worl<for which application is rnade and 1 <br /> cornply with the Stafe Contractws Law 18.27 RCW and 29G.200 WAC. <br /> City of Evereft Official Use Only <br /> - - ----___----- _ . <br /> FEE <br /> �� � � �� <br /> � PERfvIIT# <br /> �i j2/ �� � �,C�o� - 6 C � <br /> wner/Authorized Agent Signature Date (Revised 10/12/2015) <br />