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<br /> CITY oF�VERETT P�RMlT SERViCES
<br /> 3204 C�DAR STR�.�T, �V�RET7',WA 98201
<br /> {P)A�25-257-8890 � �'AX 425 257-8857 � (�}everetteps@evereftwa_gav� vuwut+.e�erettwa.gov/permits
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<br /> PROJECT ADAR�SS: D-e2/ •¢„�j^ - -
<br /> BtltLbiNG qFtEA{IP resictantial,new constructlon, modei,or ad8lfion) SF '
<br /> BUIL.pi�1G']YPE: ❑SFR-DETAGHED ❑SFR-ATI'ACNED ❑DUPLEX la MUL.TI»FAM11.Y-#OF UNfTS: �COMM�RCIAL �
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<br /> CC?I1lTl;ACT PR[CE OF W012K:$ .
<br /> NUMBER OF DEVICES{if low volta e:•
<br /> FIRE ALAi2M? ❑YES �MO
<br /> ASSUGiAT�D BIIILDING P�RMIT� if applicable: .
<br /> DESCRIPTION OF WORK: �
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<br /> OWf�tER NAl�1E; � T�NAN'f NAME(If Commerc[at: (�
<br /> OWMER MAIL1t�G ADDRLSS: srnEEr �X �j �
<br /> CFfY � 5TAT� M y� ZIP Z "��d )
<br /> OWNER PHONE: OWN�R�MAIL: ' �
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<br /> CONTRACTOR NANi�• �. G� /� �
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<br /> CONTRACTOl2 AbDRESS: srr��r P(7 $�J( �
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<br /> cot�r�acro�p�oru�: 5�2 �- � CON'TRACTOR�N1A1C.: �2!, lYt�12 !?", C�/I') ''
<br /> CON7RACTQR L[C.#{R�QU]REDJ: ��l�I�/�:C �D Z CITY 0��VER�TT BUSIN�SS I..tC,#(REQU1REb):Q�� �
<br /> PRt�lARY CON7ACT: L7 OWNER �CANTRACT�R y 1�OTHER(Pfease Speclfy)
<br /> CONTACT�[Ailli�: CONTACTPkiOAIE: 2�-73�j,-�jrjl�-(� ' -
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<br /> AGREEt�iENT.'T herehy certify that 1 have read and examJned ihls appllcallon and know the same to be irue and carrect AI!provisions oflaw.s and ordlnances goverobig thfs
<br /> type of work wlll be complsted tvhether speclfed hereio ornot. The gran6ng of a permit does nof presume fo gNe authorify to violafe ar cancel fhe pmvlslons of any ofher st�te or
<br /> locallawregulating construcfion or the perforrnance ofconsfruction That(am au(harized by the owner of fhls properly to perf'arm the work for which applfcation Is made and 1
<br /> comply wlth tha Sfate Gonfractors LatN 19.27 RCW aad 296.200 Wi4C
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<br /> OwnerlAu orzedAgen Sighature Dafe (Revlsed 90/1?12D15)
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