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���������� ������ ������ao� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVER�TT, WA 98209 <br /> (P}425-257-881 Q � FAX 425 257-8857 � (E) everetteps@everetiwa.gov� www.everettwa.govlpermits <br /> : :_, ,. , . . .. _. .. ...;._: .. _._.,. <br /> ; _ . . : . .. . _. .. . .. . . , <br /> , _ <br /> ... .. <br /> . . � . . �1t����I`�'�Q'�'�.�N����'A`�'1�9�':�:"° ` '. . �. . . ,. ::.. <br /> _ ..._ ... . ..:.... :-�... . ., . . . ...,.. .. . : ----. <br /> ,._ .:_ . ... :.. ._ . . . .. . ,. _ <br /> PROJECT ADDRESS: "r� l f� I�'�I�t �(j� <br /> BUILDING AREA{if residenfiai,new consfruction,remodel,or addition) SF � <br /> BUILDlNG TYPE: ❑SFR-DETACHED SFR-ATi"ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: S(NG Lv'' ��l `C�-� ��C✓� ' <br /> ., ,. . ..�.. . .. .,. ... .. ..,...:. .:... .. .....:.:.... . - , <br /> ..... ........ ..:..:: :.... ...:.._. : . . . .... . .>;. _.. . <br /> � � ����c�r�i���e��������i�r� wr�g��n�a��ao� <br /> CON7RACT PRlCE OF WORK:$ ' <br /> NUMBER�F DEVICES(i low voltage):� <br /> FIfiE ALARM? YES ❑iV0 <br /> ASSOClATED BUILDIAIG PERMIT#(if applicable): <br /> DESGRIPTI�N OF WORK: �., � C(�J�M`t' 01tiI�!/✓ ���v <br /> .... -- ..:. .. .. . , - , . . _ ._....... ... ... ..:. . . . _. . -. <br /> .... : :. ..: .. ... <br /> :: :. . -� �. :�.� ..CONTACT�INFORMATION..::.:�: .. : - <br /> OWNER NAME: t��J �� � t� � TENANT NAME(!f Commercial): <br /> OWNER MAILING ADDRESS: sr�teEr �l �� ,�(iY�- <br /> �� �Jr�f��y�� <br /> CIN v�V��� STATE G� 7JP /�` "`�� <br /> OWNER PHONE: ��'S ZS ��Z� OWNER EMAIL; <br /> CONTRACTO:R NAIV(E: <br /> CONTRACTOR ADDRESS: s-rReEr � <br /> CIIY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LfC.#(REQUIRED): CtTY OF EVERETT BUS(NESS l.IC,#(REQuiRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHOME: !�',�.��� "�L� ''7�� <br /> . < �� �^1 M�y� � , �l r�— CQNTACT EMAIL: <br /> AGREEMENT.-T hereby cettify thaf I have read and examined this app/ication and know the same to be Irue and correct. Al!provisions oflaws and oniinances goveming this <br /> type of work will be compieted w6ether speciBed herein or not. The granffng of a permit does nof presume to give authoriiy fo violate or cancel the provisrons of any other state or <br /> Jocallaw regulating construction or the performance of construction. That 1 am authorized by the ownerof this property to perform the work for which application is made and! <br /> comply with fhe State Contractors Law 98.27 RCIN and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> . � � <br /> ��� <br /> PERMiT# <br /> -(� .�� f- �-�g � l�b b I� �1 '� <br /> Owner/Aufhorized nt Signature Dafe (Revised 90/92/2015) <br />