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1 'I-28-16; 11 : 59AM; From: To: 14252578857 ; 4257413521 # 1/ 1
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<br /> CITY OF EV�RE7T PERMIT SERVICES
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<br /> pROdEC7'ADdRE55: � Q� 1'11 �, ��. �,,,�. , „��.;_ ,,, � ..,,�",t.t„Pu�'Y`Ir��."'r,t'P'.',?�'ck«4�,�'�,`,r?,�",,�?:�it�., � , . �r .ip% ; �
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<br /> BUtLD(NG AREA(If residontial,new consfruction,rerriodel,or additlon)
<br /> 8Ul[.DEtuC TypE; ❑S�R�DETACH�p C!SFR-ATi'ACHED �pUP��X C#MUI.T!-FAMI Y-#OF UNfTS:
<br /> U5�OF$UILDING: �C��p COMMERCIqL
<br /> e��Ll�yi � yNA��i'I�,li�t w(�Y �:�'!k v�)�+,�°A�.M 9 f d,� .0 ��}L' ur�/� L�y
<br /> W�.,J ��.t9��t�.�:4�1 ilu A �^:::!1, r3t'x���:���+�FP�^�,l/rya Yh'��Y:��"��49����i"�����yp.y �'�'�d�ry�I� �y-�(t�1 Y y�� f
<br /> CONT .,. .Ti � .o., H.., .�.q4,n, .�G�Uj�,6�W��+f1���11��r.�l.Y�O�IY.oi1)C,&���tl�i�,�,�r.;�'<l�w.�j� �, �.:���`, ���r�� ,,�" `�:�,�+tt � '°� �
<br /> w�cr Paic�oF woRK: � �' ryZp��.� � �;; ��� ;, ,�.,< <�» �� f����;.�;�,
<br /> NUM�ER OF DEVlCES if low voftage :
<br /> F1R�ALARM? ❑YE5 � NO
<br /> ASSOCIAT�D BLlILDlNG P�RMIT# if s licable :
<br /> D�SCI�lpTfON OF WOi2K; ` 1 ���
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<br /> OWN�R NAME. S� l owta-v� I� �l 1�• SC�ts� :,.. . , ,. -�
<br /> TENANT NAME(If Comtnerc��l : .S�L�ILYl•I�yi `G�'f' ,S'��zat�I
<br /> OWf�fER MAE�ING ADDt2ESS: s7t�Ect.
<br /> `�5?�6 d`h�'- ,5��
<br /> CfiY `'C.�,(C��i'1�+ &TAlL ��'{] ���
<br /> owr��a pr�onr�: � y`�/- � z�P
<br /> � owrv�R en�a�:
<br /> CONTRqCTOR iVAME: t��,-t�y �,u- `��
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<br /> CONTRqCTOR ApDI�ESS: 5��� 1• �j-h �-� r� �C,
<br /> cmr t„y y'LW'-D O C� �
<br /> eONTRqCTOR PHO�E:��- �"`� + STA7E Z�p O �� �--
<br /> 35�2� cotvrt�,acrotz�m,��L: c1�e7c� �Sl i,a��-- f c��v7
<br /> CONTRACTOR Ltc,#(REQWRED):�}�j�11 cS�j,3�,/ C��r��EV�R�iT Bl,f$�[�J�SS�IC.��(R�Q�IR�D:
<br /> PRIMARY Cp�TqCT: ❑OWN�R C + � D
<br /> ON7RAC70R ❑07HER(PlEase Spooify)
<br /> cON7ACT NqME:
<br /> �� �,��� COfdTACT PHON�: .�.'�j; �"� I � �
<br /> CON1'ACT EM/afL: �(�K ,� ��YJ�� �,y�� ,��.�-7
<br /> AGRE�MENT,•l haroby caRify thaf!havo reatl and oxaminod thJs applicot/on and know tho samv to bo trua and corrc�cL A11 pro�Jslons of/Aws and ordlnnncos govoming lhls typo
<br /> °l��Wrr/6v complotod whethor spoclllod horr3ln or not. 7ho granpng Q�a PQ��I tloas not prosumo!o glvo authodty 10 v!olalo o�canco!tho prav/slans of any olhor siala or
<br /> �eca/1aw rvgulefing construc�/on or tho pe�or,r,ancn ol conslnrccfon. That I am au�horizod 6y tho owner of tnls proporty to porform!ho work for wHlch apppcal/on fs inedo nnd/
<br /> CO�"AlY kdlh Iho Sta1Q ContrJ�lors Law J8,27 RCW end 296.20o WAC.
<br /> � Clty of Everctt Off7c(al Uso Only
<br /> wERMrr#
<br /> ownor/A thorib d AgcnE Signatura
<br /> �, � � � �� � ��SJ �C r \� �
<br /> Dato (f2ov/cotl 9/23/2096)
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