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<br /> CIl'Y OF EVERETT PERN!(T SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 58201
<br /> (P}425-257-8810 � FAX 425-257-8857 ( (E)everetteps@e�erettwa,gov � www.everettwa.gov/permits
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<br /> . . PRO.�ECT $�TE INFORMATION
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<br /> BUfLDING AREA(if residential,new construction, remodei,or ac�9i�ie5n} ��
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<br /> �UILDING TYPE:; SFR-DETACHED 0 SFR-ATTACHED ❑DUPIEX_ ❑MULTI-FAMILY-#OF UNITS; � COMMERCfAL "
<br /> USE OF BUILDING:
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<br /> ,. .. � ��`��l�APP�.I��`��N f�FQ.�i,N�T`14�!
<br /> CONTRACT PRICE OF WORK: s `
<br /> NUMBER OF D�VICES i�low��ai e �
<br /> FIRE ALARM? ❑Y�S :❑NO _ '<
<br /> AS,�t��IATED BUILDING P�RMIT# 3f�... li�able ;� ,' , .. -�0
<br /> �ESCRIPTION OF WORK:
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<br /> pF�fif�1ER NAMEc �rr �c.�Yl�2. `: �i"�•���7$I�O TENANT NAME !�C�mmercia{�: ,
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<br /> QWNER MAIlING ADDRESS: snteEs � '
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<br /> :_WNER PHONE:_ZOG ���� 3�'I ;..:. OWNER EMAIL.
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<br /> GONTRACTOR NAME: : ; . . '� ;
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<br /> i��tTR�GT�i�ADDRESS: __ sa�x�_
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<br /> �l'�t�iTRACTOR PHONE� , _ �� CONTRACTQR�1V���:A , ' � < �3��
<br /> �+�,3�`�I�tCs�'��1,:��"r�����E��,_ G1�Y OF EVERETT l�l�S�t��Bl,�L.IC.#�Et�UI��: '' � -
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<br /> PRIMARY GONTACT: 0 4WNER ;�'�T��'t�l�: ❑OtHER(Please Specify)
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<br /> CON7ACT NAME: ,� CONTACT PHONE: "
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<br /> ,� -. CONTACT EMAIL: . . ; �: ��
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<br /> AGREEMENT:T hereby ceriity ihat 1 have read and examined lhis appUcation and know ti�e same fo be tn,re and wneck Al!provisions of(aws and�i` �s govemrng this
<br /> type of work wili 6e compfetad whethe�spec�ed herern or not. The granting of a permit does nof presume to give auihority to vlolafe or cancel ths provisions of any other state or
<br /> loca!law regulating canstrucNon or the performance of constructlon. That I am aufhorized by!he owner of thrs propetfy to perform ihe work for which applicafion is made and t
<br /> comply wi[h fhe S1ate Contractors Law f 8.27 RCW and 296.200 WAC.
<br /> G�y of Evereft Olficial Use Qnty.
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<br /> 'FEE __ _
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<br /> PERMET#
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<br /> = OwnerlAuthorized Agent Signature Qata (Revised i0/1772095)
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