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<br /> CfTY OF EV�RE`3"T PERMlT S�RVIC�S
<br /> 320Q CEDAR STRE�T, �VERETT, WA 982D'[
<br /> (P}�25-2�7-8810 J F'AX A�2�257-8857 ( (E)everefteps@everetlwa.gov� vwdw.everettwa.gav/pertnifis
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<br /> PROJECT ADDR�SS:
<br /> EUILBING AR�A(if residentiat,new construction,r adel,or addition) SF '
<br /> BUIC.RING TlPE: CI SFR DETACHED ❑SFR-A7TACHED ❑QUPLEX CI MUI..T{-�AMILY-#OF UNCtS: �COMM�FtCIAL
<br /> U3E OF BUILDIfVG: O��f�(7 '
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<br /> CflNTRACT PRICE OF WqRK:$ •
<br /> NUIV(B�R UF DEVIC�S ifi low voltag ).•
<br /> F1RE ALARM? ❑YES O
<br /> ASSOCIATER BUIL.DING P�RMIT#(if app{icabie):
<br /> DESCRIPTIQ�C O�WORK:
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<br /> OWfdER NAME; � TENANT NAME(If Commerclal : � (�
<br /> QNM�R NIAILII�FG ADAR�SS: sTa�r �X � .
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<br /> OWNE!?PHONE: OW[d�R�MAfL:
<br /> COMTRACT4.12NA11+1�: ; �n uL� IC�/�-�
<br /> CON'FRACTOR ApDiZE3S: srR��r Pa f3t�x
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<br /> CaNTRACTOR PHONE: -Z �- � CONTRACTQR�NIAiL: /L!, /1?���2 / . L�D
<br /> CONTRAC7'QR L(C.#REQUIftED}: (,��N� C `7'Qz CiTY OF EV�RETT�USINESS L[C.#�(REQUIREI]).�O5
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<br /> PRIMARY CONTACT: ❑aWNER �I G�N7RACTOR ❑OTHEft(Flease Speclfy}
<br /> C4iVTRC'I'NAME: CONTAGT PHOIV�: ��-73 6"�Q.r7��(J
<br /> • T�C�J�1� Cl�-D4/�I GOIVTACT EN[Af1.: �]�J��f�.�,l���t! � �1�V1/1 T. �D�
<br /> AGREEll�N7•T hereby certffy that!have read and examinert thls applicatian andknow the same to be trrte and correct. A!lprovistons of la�!s artd ordJnances goveming this
<br /> type of work vrfN be completed whether specified herein or not. 7he granting of a perrnit daes not prc�sume fo give autharily fo vlolate or cance!fhe provisfans of any afherstaie or
<br /> locallaw regulating construation or fhe parformence of construction. Thaf I am authorized by the owner of fhls properiy to perform the work for which application is made and 1
<br /> comply wifh the State Contraotors taw l8.27 fZCW and 296 2f10 WAC,
<br /> City of Evereit Officia!tJse Only
<br /> FEE
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<br /> pERMIT#
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<br /> OwnerfAu orzed AgentSlgnafure Date (Revised 90/12/20�t5}
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