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<br /> C1TY OF�V�R�TT PCRMIT S�RVICES
<br /> 32Q0 C�DAR S7R�ET, �V�RE`i-f",WA 98201
<br /> {P}�25-257-88�D j FAX A�25-257-8857 � �E)everetteps@svereftwa.gov� www.everetfwa.gn�/permits
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<br /> PROJEG7 ADDRESS: �
<br /> BUIi,DiNG ACt�A(iF residentiai,new construction,remode addition) SF , '
<br /> Bi11l,bINC 7YP�: ❑S�R-DETACH�D ❑SFFt A7TACHED C7 DUPLEX I�MU1�TI��ANfILY-#QF UNlTS; �COIVIMERCIAL
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<br /> CONTRACT PR[CE OF W012K; $ � •
<br /> HLIMB�R OF DEVICES(if low voltage)»•
<br /> �1RE ALARM? Ci Y�S NO
<br /> ABSOCIATEA BUII.QINC PERMTf#{{f appiicable: .
<br /> DESCC.(pTI�N OF WORK:
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<br /> QW[�IER t�AME: � 7�NAN7 NAIIN�(If Commarcia!: ��
<br /> QWMERNIA[LtNCADDRESS: snt�r �JC �j � �
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<br /> OWNEIi PHONE: OWNER EMA[L: '
<br /> COlVTf2ACTO.R NABII�: (,� /(�
<br /> �o�►r��To����R�SS: �R� Pa $ox
<br /> C17Y f,/� I L � SI'AT�`j 21P �Q .
<br /> coNrw�crot��xotv�: 5-z �-� � C�Mi'RAC7l�R EiNAIL: �}-�E?/, /Y)�—i2 !T� CD/�
<br /> CONTRAC'fOR LIC.#(REQUIRED}: ��I�J��,'C �D,z, C[TY O�EVERETT BUSINESS L.IC,#R�QUIRE[3):Q�O
<br /> PWMARY CONTAC7; �OWNER �I GON7RAC70R � ❑OTf-lER(Flease S�ecify} �
<br /> CON7ACTNAINE: CONTAGTPHONE: ��•73��^�ps`�'.�p
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<br /> AGREEMEN7:�7 hereby celtily ihat7 have r�ad and examined[hIs spplicahon and know the same to ba true and corr•ecf. Al!provisions of law,s and ordlnances governing th�s
<br /> fype of work wfll he campleted whether spec�ed herein or nof. 77�e granting of a permit doss not presume to glve aufhortfy to violate ar cancat the proWsFons of any otherstate ar
<br /> local!aw reguleting constructlon or the perforrnance ot consirtrctlon 7hat l am authorized by the owner of this properly to psrform fhe wrork for whlch appAcatlon is made aod!
<br /> comp/ywith the Sfafe Contrerdors Law 98.27RCWand 296.200 WRC.
<br /> Ci�y ofEverett pfficia!Use Only
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<br /> OwnerAu or zed Agon 3ignature Dafe (Revfsed 9Wi2/201b}
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