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C�C��G30�Q1� �C���li � 1( 1���1�dC��;�f Il��
<br /> • CITY OF EVERETT PERMIT�ViCES
<br /> - 3200 CEDAR STREET, EVERETT, WA 982Q1
<br /> (P)425-2�7-8810 � FAX 425-257-8857 ) (E) everetteps@everettwa.gov � wwvv.everettwa.gov/permits
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<br /> PROJECT ADDRES�9: � �S� S"� • v1 � �
<br /> BUlLD1NG AREA(if residenfial, new construction, remodel, or addition)�7'� ��^'� 4� SF
<br /> BUILD(NG TYPE: ❑ SFR-DETACHED ❑ SFR-ATT/�CHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING: ��`�«c '
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<br /> CONTRACT PRICEi OF WORK: $ �j ,�
<br /> NUMBER OF AEVI��ES (if low voltage):
<br /> FIRE ALARM? ❑YES �O
<br /> ASSOCIA`fED BUIt_DING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: p •k �- 5�� Yv�, � � � T'�
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<br /> CO_N.TACT INFORMATION -
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<br /> OWNER NAME: l"l�' uf'b�,� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReEr Zl�'� S� �y �
<br /> CITY � STATE ZIP C 2 G
<br /> OWNER PHONE: Q-Z� ZS Z, ��'j I�}' OWNER EMAIL• --
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<br /> CONTRACTOR NAME: v �t;l `
<br /> CONTRACTOR ADi]R1=5S: sTReEr t�j4 Z C�,fih �
<br /> � CITY l STATE ZIP \ � (�
<br /> CONTf2ACTOR PHONF=: (� I� CONTRACTOR EMAIL: � � �p• a � ��,i,��(' t/�L LOL
<br /> CONTRACTOR LIC,#(REQUIRED): ��Df��,�.,, ��"J � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):,�.`;';:�' ` r "•
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<br /> PRIMARY CONTACT. OWNER �CONTRP,CTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: "n/1 • CONTACT PHOIVE: G�ZL� "7 Z���� �
<br /> ����, ���R,����V��-�o
<br /> C(�R CONTACT EMAIL: ��,p ``'� ��PDf�tIJ 1 N�l,l,S��R l(r'�I�� C 81N1
<br /> AGREEMENT.�T hereby certify thaf 1 have read and examined this applicafion and know the same to be true and correct. Al1 provisions of laws and ordinances goveming fhis
<br /> type of work will be complefed whether specified herein ornot. The gianting of a permit does not presume to give authorify to viotate or cancel the provisions of any other sfate or
<br /> /ocal/av✓regulating construction or the performance of construction. That/am aufhorized by the ov✓ner of this property to perform fhe work forwhich application is made and l
<br /> comply with the State Coniractors Law 98.27 RCW and 296.200 WAC.
<br /> Cify of Evereit Offcia!Use On/y
<br /> FEE
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<br /> / PERMiT#
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<br /> OwnedAuth rized Age Sign tur Da#e (Revised 10/92/2095)
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