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������.���� ������ .�������o�� <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 j (E) everetteps@everettwa.gov� www.everettwa.govlpermits <br /> • :. :. . . . ... . :,.. . .. , . .:.._ __..,.:, ..:_...._.._._ . . __ . . _ - <br /> .._. , _. .. . <br /> :� � . . :. �R��9��'P';��`�'� ����R�B�'�'��9�':,�.° � �'. ;.•.. . . . <br /> . .. . .. ,.. . _.... . .. . ._. . . . . . . .. <br /> ... .... ..:. :. :. . . . . .. .: . _._ y <br /> PROJECT ADDRESS: / OQ� �O � S / ' S ���' / T �� ` p � <br /> BUILDING AREA{if residentiat,new consfruction,remodel, or addition) � S� � <br /> BUtLDING TYPE: ❑SFR-DETACHED ❑SFR ATTRCHED ❑DUPLEX CI MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILA1Pd�: �S I��/W I ��L . . <br /> ;., .. . �.. ... .... . : ..... �.: .�.._-:..:...:-,... .-:..:..... ... .. - . ., ..... .. ,..._ ....:...__ ::_.. .,...,., • - <br /> . ... ,:.:, .. . ..... . . . <br /> �L�C7"9Z��Aflm AP��ICd��`�OIV �9�l�ORMA`�°'�ON - <br /> .. � .. . . .... .... .... . .... .... .: : . ... ... ., . <br /> ._ . .._.._ .,_ .... .. ....... ....._ .. . . .�. <br /> COIUTRACT PRICE OF WORK:$ � ' � � <br /> 11tUMBER OF DEVICES(ifi low voltage):� <br /> F1RE ALARM? ❑YES PIO <br /> ASSOCIATED BUILDIAIG PERMIT#(if applicable): <br /> DESGR(PT(Old O�WORK: /�JS'� Z L/N D w'�fZ � � % <br /> ...... .... .....:: .... - - - . . .. . _. _ - - . .. . . <br /> .:..: :_ _- . . � - . _ . . - <br /> . . ...... <br /> _. ... . : . _ _ <br /> :::, �.:.., , . ... . _ -,_ .'` _ _ . <br /> . ._ ;.: .;-: ::� ..GONTACT-INFORMATION.-�:. , . � <br /> OWNER NAME: �/l��S s�'1 / / �f TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sreeEr ��(`� �O � s�' /� <br /> CITY �� T/ � � STATE (�V J` ZIP ���/Q <br /> OWNER PHQNE: Z�' ,�I-� "J?�O / OWNER EMAIL: <br /> CONTRACTO:R NAME: � <br /> CONTRACTOR ADDRESS: s-rxe�r ' <br /> � CITY � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(RE4UIRED): CtTY OF EVERETT BUSINESS LIC.#(REQUPRED): <br /> PRIMAI2Y CONTACT:� OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � <br /> ° v�/V G�S �/'l I f /T CONTACT EMA(L: <br /> AGREEMENT.�T hereby certify that 1 have read and examined this application and know the same to be true and correct Al!provisions of/aws and ordinances goveming this <br /> fype of work wili be completed whether spec�ed herein or not The granfing of a permif does nof presume to give authority to violate or cance!the provisions of any other state or <br /> loca!law regulating constr�ction or the performance of construction. That I am authorized by fhe owner of this property to perform the work for which application is made and t <br /> comply with the Stafe Contractors Lainr 78.27 RCW and 296.200 WAC <br /> City of Evereft Official Use Onty <br /> FEE <br /> � ��°� <br /> (� —�_ 0 / I 7 � M1T# r .... <br /> Z � � �i�� ��� <br /> Owner/AuffiorizedAgentSignature Date (Revised 90/92/2015) <br />