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<br /> ;.,,` ��' � C1TY OF EVERETT PERMIT SERVIC�S
<br /> 3200 CEDAR STR�ET, EVERETT, 1/l1A 98201
<br /> (P)425-257-88'10 � FAX 425-257-8857 j (E) everetteps@evereftwa.gov� www.everettvva.govlpermits
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<br /> - I�G���L C�`i('(' �➢'1�L DI�JPOG�G�#li�`�'Q�Of�l
<br /> PROJECT A�DRESS: ! 9�� !�!�� .�, L_� ��_
<br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED „�7 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF RUILDING: �j,��,,,�.�� _ _
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<br /> LL�I�C�'G'�OC�I�a�pf��OC��l�0 o0I�1 dR7G�0O ft�Gi�LaS�t'OQG�I ,
<br /> CONTRACT PRICE OF WORK: $ / /�r;�y
<br /> �IUMB�R OF DEVIC�S (ifi low�oltage);
<br /> FIRE ALARiVi? ❑YES �}�O
<br /> ASSOCIATED BUfLDI�lG PERMIT#(if appiicable): /✓�r
<br /> DE5C121PT10�1 OF 1l4lORK: ��� i7 �E-� i,� �'�' ���-
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<br /> �._. ' � - ��N`��c�� �����MA'�9��9 -
<br /> OWNER NAME: �, �. �,r,i- � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sraEEr f ✓, j �'c�- �`c���
<br /> crrv �✓c,r�.� s-rnre L✓c.- ziP J�'Z���
<br /> QWNER PHONE: ��S�' �C,?� �' -S� OWNER EMAfL:
<br /> CONTRACTOR NAM�: (� �' -� '��- GG L
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<br /> CONTRACTOR ADDRESS: sTReEr p �;, �'_S ��� ,t��
<br /> C�N ��;�. .L C,�L .^" STATF G�/��� Z�P � n`� _..
<br /> CONTRACTORPHONE: L�,ZS - ���3 �y CONTRACTOREMAIL: ���lY'�; �I���-r,� � . � J;�C-�=�"-e
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<br /> CONTRACTOR L(C.#(REQUIRED): c�y?,/� �"r C ''`'/J ��✓ CITY OF EVERETT BUSINESS LIC.#(REQUIR D):
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<br /> PRIMARY COIVTACT: OWNER CONTRACTOR ❑OTHEFZ Please S eci
<br /> CONTACT NAIYIE: / CONTACT PHONE: LlZ�"- s?�} _��Z 5''
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<br /> � ��� ,{�� CONTACT ENIAIL:
<br /> AGREEMENT.-T he�eby certify that 1 have read and examined this application and know the same to be irue and crorrect. All provisions of/aws and ordinances governing this
<br /> type of�vork will be completed whefher specified herein or not. The granfing of a permif does not presume to give authority to vio/ate or cancel the provisions of any other state or
<br /> locai law regulating consfruction or the periormance of construction. That l am authorized 6y fhe owneroi this property fo perform fhe work ror which applfcation is made and I
<br /> comply with ihe Stafe Contracfors Lav�98.27 RCbV an.d 296200 WAG.
<br /> ' Cify of Evereft Otficial Use Only
<br /> FEE
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<br /> �� G'�� �� l � 7 � l. � O + � �`CJ
<br /> OwnedAufhorired AgentSignature Ua e � (Revised 10/17J?_095)
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