|
��������a� ������ ���������� .
<br /> `' ''_�� ` C1TY OF EVERETT PERMIT SERVIC�S
<br /> ��
<br /> 3200 CEDAR STR��T, �V�RETT, 1NA 98201
<br /> (P)�2�-257'-8810 � �AX 425-257-8857 ] (E) everetteps@evereitvva.gov� www.everettwa.gov/permits
<br /> ;:_:.�.,;;- :.:� .:... . .. ...:....:. .. ...: .. .... . . _
<br /> , _ �:�.. ::.:..........�._.:�.�...:. ._.:.., . .. . _ _ .
<br /> . . . ,. . . ._ . , : IPI�C��B���t' �q_`�I� Ii�L�.��k�a�,'�'B��:�,:.`._:.��� :.,�, .,,,,.. ..:;
<br /> ,.:,.._.�.._......: ....:.............. . ... ....: .......... ... .
<br /> ��o��cr��o�R�ss: _��- -?- C�('�-.�-NT ,�
<br /> BUILD]NG AI�EA{if residential, new consfruction, remodel, or addition) ��C" S�
<br /> SllILDING TYPE. ❑ S�R-D�TACNED ❑SFRATTACHEJ� Ll DUPLEX ❑ MULTI-FAMILY-#QF UN1TS: L1 COMMERCIAL
<br /> U5E OF SUILDIi�IG: (r�,�"'f�'�' � � �
<br /> - ._. .,.... , . . - .
<br /> f .: ��;1��`�'➢3����,�IIa�L�II�G����G�( ➢��`Q���t1��6�1� - _
<br /> CON7'1�AG`i'PRIC� O�V�ORK:� ` v�i Ci , �—"
<br /> IVUMBER OF DEVIC�S (ir`low voltage); �
<br /> FIRE ALARfVI? ❑Y�S L�I N�
<br /> ASSOCIATED BUILDING PERINIT#(if applicable):
<br /> 1 =i � � � (s,P,� 4� `� '���/'/`,����r`, �/1� � *� ' v� F
<br /> DESGRIPTION OF WORK: � � � '�" l�% �' "� '— �
<br /> � � ;�';�-,Jt; � .
<br /> �
<br /> ....: . ...., ..-��---.:.._.:_�.___..�_o,.._,:_,..._- - � - - ---
<br /> . . .. . -. -....,:..;: .,,_...:.. :::. .:. : ...� . _
<br /> -..
<br /> ..:<:. j:.. :. . ...: :. . .
<br /> � � -. CON'TACT�IN.FORMATI,.-ld;. .: ..._: ::� - -
<br /> �y�������,�;.' ��ar,�.�� - r� '-'��l. TENANT NAME(if Commercial):
<br /> OWNER MA[LING ADDRESS: srr�eEr �� � �1 ���� � -'��
<br /> f� C� ;� � �
<br /> �5...�. CITY _ � � Y ' �� I I STATE 1/�/' ZIP I (1 ,� �
<br /> OWNEi��-lOisE: OWNER EMAIL; � •
<br /> �.,..:�:�,�.:.,:..:v...,�.,__.� ,...._._ ..
<br /> nCONTRACT01�NAME: ..,._. V�:.-` 'L _ C I �� I C- lJC_
<br /> CONTRACTORADDRESS: s�aEer - � � �'TM �y
<br /> r-r--r ,� /� � C y
<br /> CITY �..�- � �i� STATE 7�P �
<br /> ��� •- �-G C�' �t CONTR�IGTOREIV(AIL: (���-1�l Ci �I "�� � , �-U./1'�
<br /> CONTRACTOR Pi-107�7E: '�
<br /> t� � �� � �
<br /> ^" CITY OF EVERETT BU51NES5 LIG.#(REQUIRED):
<br /> COI�ITRACTOR LIC.#(REQUIRED)= I� ! I _I�- - ' � ....,._._�,,.._,,..u.}:.._.��..._.�.e.�....,.-..__=v.ti.�.,.._,..._.,.--._•-,.
<br /> PRIMARY1CONTACT.K`CI'OWNER � L�CONTRACTOR CI O�NER(Please Specify)
<br /> CaNTAC7"fVAME: GONTACT PNOIVE: ��"1 � �,�-'� � � � �;
<br /> �j7 '��'FF- '� CON-i'ACT EM1aIL:
<br /> AGREEMENT.�T hereby cer�ify that l have read and examined this applicatron and know the same to be frue and correct A!lprovisions oflaws and ordinances goveming this
<br /> iype oi v�ork will6e completed v✓hetherspecified herein otnof. The grantrng of a pe�mit does notpresume to give auPhority to violats orcancelthe provisions of any oiherstate o�
<br /> locallawregulafing construction orfhe periormance of construction. That!am authorized bythe owne�ofthis properfyfo perform the tvorkforwhrch application ismade and!
<br /> comply v✓ith the Stafe Confractors Law 18.27 RCW and 296200 WAC.
<br /> City ofEvereit O�cial Use On/y
<br /> FEE
<br /> �� — --
<br /> j PERMIT#fi
<br /> � �--� �-r_ ,,> - j� � � (�05-- �g g
<br /> OwnerlAufFiorized Agenf Signature Uate (Revised 10/1212015)
<br />
|