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L������o��� ����a� ������n�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'1 <br /> (P}A�25-257-$89 0 � FAX�25-257-8857 � (E) everetteps@everettwa.gov� www.everetiwa.gov/permits <br /> ...,.. :. , ,: . _ . . . . . _ .::: ..... .... ... . ........ ..._.:.._......_.� :�_:-.__.:,v ....... ... <br /> . , .: . ������`d':.�Q'�� 8������`�'���;': �' ._ . <br /> PROJECT ADDI2ESS: �f r �j.�.�G {V�.�-.Q <br /> BUILDIIVG AREA(if residential,new consfructi ,remodei, addition) SF � <br /> BUILDIIVG TYPE:�(SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: R„qr�, pl..�,h,� , - <br /> ;,,. ; _. . _. .,. .... .. _ ..... � ...._..:.:. ._.. . <br /> . _. ._;.�-: : .:.;, <br /> . .. . <br /> ��;�C'�'R�CA�,API��S�A`I�S�� 9���R�/��'AOId . <br /> _.. . . .. .. : ....,. : : . ... _ _.. . . . _. .. , . . . . _... . . .. . ...,_. .. .. .. . _ <br /> CO➢dTRACT PRICE OF 1NORY:� '� � C� �, C�� � <br /> AIUMBER OF DEVICES(if low volfage):� <br /> FIRE ALARM? ❑YES �O <br /> ASS�CIATED BUILDING PERM(T#(if appiicable); -'"'"'r <br /> DESCRIPTION OF 1nIORK: �Q I � t � r'� <br /> \1.� . <br /> .. .... ..... ..:.. � : . .. . _ . ...., ..::....: ..,.. .�-:._ :, A� . - - . .. .. . -. - _ _ . . _ <br /> .. . . . :..::.:. . . .. .... : <br /> _ ..: . <br /> .. _. _ .. <br /> _. ..' _ . � :.:...,:OI!7i' ..: T:INF,ORMI.�TIOW- :.. .. : - <br /> OWNER NAME: �.Y' �v� C�'� TEMANT NAME(If Commercial): <br /> OWNER MAILW G ADDRESS: s-raeEr �G oJ Q• 1'1 �r <br /> �� �= �I STATE v,/p Z,P 9 a�3 <br /> OWNER PHONE: OWNER EMA[L: <br /> CONTRACTO:R NAME: S i r� i � �P r � <br /> CONTRACTOR ADDRESS: sTReEr 1 I � <br /> ��,Y r_ �- STA� w/� Z,P <br /> CONTRACTOR PHONE: �a 5 ��3 ��3'� CONTRACTOR EMAIL: JG,., 3 �i rr,Pv� 1 n Q ��G <br /> COIVTRAC70R LIC.#(REQUIRED): 3 ((�'� E p l� �6 �'j- CITY O�'EVEI�ETT BUSINESS LIC. REQUIRED): <br /> PRIMARY CONTACT:� CI OWNER x � CONTRAGTOR ❑OTHER(Please Specify) <br /> CONTAGT NAME: CON7ACT PHOME: (,�'� a 8 L� � <br /> n\ f CONTACT EiV�.4IL: .f <br /> J C�V� f 1 �t'1 PC� r^�C„ .�+ <br /> AGREEMENT.�T hereby certify th have read and examined this application and know the same to be true and correcf. AlJ provrsions of/aws and ordinances governing fhis <br /> fype of work will be completed w ether specifred herein or not. The granting of a permit does not presume to give authorify to violafe or cancel the provisions of any other state or <br /> loca!!aw regulating construcSon or the performance of co�sfruction. Thaf 1 am authorized by the ownerofthis property to perform fhe work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCV11and 296.200 WAC <br /> City of Everett Otficial Use Only <br /> , FEE <br /> . ' l� �. <br /> PERMIT# <br /> r � +� � ���� � v� � <br /> i � <br /> Ow erlAufhorized Agenf Sig ure Date (Revised 90/92/2015) <br />