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_ __ . �ozgZs-y�zz.�� ��'�9� <br /> EL��1'R�C�4� �E6��lI�T ,A�PL.IC,�,`TIC)N <br /> C1TY O�EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425 257-8857 � (E}everetfeps@everettwa.gov� www.evet'ettwa.gov/permits <br /> . _ .':.. .. � ' _ — __ ,O� '�Y�r ��O^..•J.. js . �h:�•`3� <br /> . . :pROJ�4T�.SIT�:�Ii�� :4Z:..!A._ .N <br /> - -•:...:_::a .:._ .....:: <br /> ::,:.. .,.. - ���..` <br /> PROJECT ADDRESS: <br /> BUILOING AREA(if resldential,new construction,remodel,or dition) S� <br /> BUILDING'iYPE: ❑SFR DETACHED ❑SFR-ATfACHED ❑DUPLF�C Cl MULTI-�AMILY-#OF UNITS: �COMMERCIAL <br /> us�oF Bui�niN�: OE G EVEP_�`IT' ' <br /> ..1:•..: � <br /> _ �r�'"- ��(y /� - �OR� �T[OI�M� �,;� - <br /> . . y�AT�ONr�...� 1�ItA. .:r��... <br /> .. "�.E�T� �IC�L�:ApPLI� .�M. _ <br /> �T .._;T.. .;� ,�.� .•.•Ca..��: •V4•:. <br /> CONTRACT PRtCE OF WORK:$ � <br /> NUIVIBER OP UEVICES(if low voltage:• <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATEb BUILDING PERMI7# if a licable: <br /> U�SCRIPTION OF WORK: . <br /> - . .. , .. ..�... „; . ,.., ., <br /> °.7, _,. . . � : -� , . -:,.. �G0,1�7'ACT`INFORtI�IAT�ON. . .-:��. =�-�_.. <br /> , :�+..- � - - <br /> OWNE[2 NAME- TENANT NAIVIE(lf Commercfal : � <br /> OWNER MAILINC ADDRESS: smeer F7OX J �y <br /> CITY �,�r� STATE rV y /� "�Gv� � . <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACT�R NAME: � � � <br /> CON7RACTORAqDRESS; srR�r PO SOJC /� <br /> CITY I L V �A'�"�'" ' LP �DA <br /> CON7RACTORPHONE: 'Z �' `7' CONTRACTOREMAIL: /e�a II��rI� � � `D� <br /> CONTRACTOR LIC.#(REQUIRED): (?�N�/� �D Z CITY OF EVERETT BUSWESS LIC.#{REQUIRED): O <br /> PRIMAIZY CONTACT: ❑OWNER �CONTRACTQR ❑OTHER(Please Speclfy) <br /> CONTACTNANIE: CONTACTPHONE: Z�'73b"�S��p . <br /> . ��'N�I S �iC.'b(�/ CONTACT EMAIL: D� 1�IS.CKOk1� K/F'W't T. L�.o/►'1 <br /> AOREEMENT T hereby ce�!!fy ihef 1 have tead and examined thls appilcatton and krrowfhe same fo be(n1e and coirect AIlprovlslons oflaw.s and nrdlnances goveming th6s <br /> type ot waic wNl be completed►vhether spec�ed hem/n ornot. The granilnp of a permlt does not presume to give authorlty to vlolate or cance/the provklons oPany otherstafe oi <br /> bcallaw regulaBng constn�ctMn or the perfom►ance of onnstrucGon. Thaf I am aafhorizedby the owner of ihls property to pe�l'arm fhe work for whlch applkatlon 1s made and/ <br /> comply-wlt�dho-�tate-6nntraclors-f.atv�$2ZRC1N_and_ oti1NAC <br /> CltyofEtre�e 0 c a se 7y <br /> . �� � Q <br /> �v� � <br /> PERMIT# <br /> _ E l��- - �2� � <br /> Owner u or zed Agen 5lgnature Date (Revlsed 10N2%2015) <br />