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<br /> CITY OF EVERETT PERMfT SERVICES
<br /> 32Q0 CEDAR STREET, EVERETT, WA 9820'1
<br /> (P)42�-257-88�0 ( FAX 425-257-8857 j (�)everetteps@evereftwa.gov] vvww.everettwa.gov/permits
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<br /> PROJECTADDRESS: � � � 'E j'J�' � �,
<br /> BUiLDING AREA(if residenfial,new construction,remodel,or addition) SF '
<br /> BUILDING TYPE: ❑SFR DETACHED ❑SFR-ATTRCHED ❑DUPLF�C MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> U5E O�'BUILDING: �,�/' •
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<br /> COIVTRACT PFZICE OF WORK:$ �� ��' '%� � ��
<br /> tdUMBER OF DEVICES(if Iow voltage):�
<br /> F1RE ALAEtM? ❑YE5 NO
<br /> ASSOCIATED BUII.AING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: � - �Q. r� � °
<br /> �`�p � � � `�' � � � �fi�I��S -� .
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<br /> � ; .�.: � - � -....� -::. :�. =°::� .;CON'TACT.:INFORMATION..:.�:.:. .. . _ - _
<br /> OWNER NAME: ' TENANT NAME(If Commercial):
<br /> OWNER MAILiNG ADDRESS: srr�eEr /� I,,,�-^ � �� �
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<br /> Cf1Y STA7E ZIP� �
<br /> OWNEFi PHONE: OWNER EMAIL:
<br /> CONTRACTO.R'NAME: � `� A
<br /> CONTRACTOR ADDRESS: s�teEr � �� � +���I.�
<br /> • C�7'y STATE ' Z(P - �
<br /> CONTRACTOR PNONE: - . CONTRACTOR EMAIL:� > .!�� ' ,� 1�'/
<br /> CON7'RACTOR LCC,#(REQUIRED}: 'r ��� CITY O�EVE ETT U5(NESS LIC.#(REQUfR
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<br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR �OTHER(Please Specify)
<br /> CONTACT NAM�: CONTACT PHONE: �� -� �/,. �
<br /> �� CON7AC7 EMAIL: � k � �
<br /> AGKEEPAENT.�T hereby certify tha I have read and examined this applica6on and know the same to be true a orrect AU provisions of/aws and ordinances governing this
<br /> type of work willbe compieted whether specified herein or not. The granting of a permit does not presume to glve authority to violate or cancel the provisions of any other state or
<br /> loca!law regulating consfruction or the performance of consfruction. That!am authorized by the ownerof this propertyto perform the work for which application is made and I
<br /> comply with fhe State Contractors Law 98.27 RClN and 296 Z00 WAC.
<br /> ' Crty of Everett O�cial Use Only
<br /> FEE
<br /> . 3 S S �-
<br /> PERMIT#
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<br /> Owner horize AgentSignature Dafe (Revised90/92/2095)
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