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�I�����a��l� I��� 1�1� l� ��l��,Q�°�— �flQ IC� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREl7', WA 982D9 <br /> (P)42�-257-8810 J FAX 425 257-8857 � (E) everetteps@everettwa.gov� www.everett�nta.govlpermits <br /> .... ,. :. ;. , .. .. .,... .. . . .... -..� _...: ...:_.: .� ___ ,....__v�.�.. .�...._. ..:. .. <br /> :-� . :. _. �: <br /> .._ ...: .; <br /> -: . : .: . � �1��J��'�' ��'�'� �d���R�:�.�!'1�94l.'..�°.'.:. : �. . . <br /> _ _._ .: . .. ..._. . ... . .... .. . ..._ ... , . _ _. . . . .. . <br /> PRO.IECT ADDRESS: ��2� /}�j���jp�} �L"'�f�"'I,Q�G t �iv�• `7 Z d,3 <br /> BU1LDIlVG AREA(if residentiai,new cons#ruction,remodel,or addition) SF ' <br /> BUILDCNG T(PE: ❑SFR-DETACHED ❑SFR-ATfACHED ❑ DUPL.EX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF SUILDING: � • <br /> , . _ , . . .._.....-:-:.... -. <br /> . . .:. .. .•-�--:..:.- - --- <br /> . . ... ,.. .. . . .:.. . ._. .. <br /> , -..;.... . <br /> ` �E�', 7'ItIC.4L.A PI��CA`�'1�IVI IB�I�ORNIA`�'ION <br /> CONTRAC7'PRICE OF WORfC:$ � (�Q , � <br /> NUMBER�F DEVICES(ifi low vo(tag :� l <br /> F1RE ALARM? ❑YES NO <br /> ASSOCIATED BUlLD1iVG PERMIT#(if applicable): <br /> DESCRIPTfON OF WORK: �Qg pv�' !Z� WIG� `.S^�� CP�/�4'�'it �u!/D'�Ni <br /> ,.. -- ..:. .. .., � . . . . .--...,_ .... ... .:::- .C..., _ - - - . - � - � - -- - <br /> . .: .. .. ... ..... <br /> .: <br /> -: ". ' °- - � :_ ., ONTACT;INFORMATION.- -.:: .. : - - <br /> OWNER NAME: E'/1.����� £'�j Q?t� �I mercial): <br /> OWNER MAILING ADDRESS: srReEr G:�Z �rj0 /�J <br /> � CITY �.U (L.�f�( � STRTE � . . ZfP �O �d <br /> OWNER PHONE: �Zs' �07�ly 7UfJ OWNER EMAIL:fZJ.�, , r��nc,��c.a�1�E.��r�G�.�.�vE 7�.�►rl �G�G' <br /> CON7'RACTO:RNAME: ►e{G� £f..��'-Ti�1(�° G.L� <br /> CONTRACTOR ADDRESS: sTReEr t 3 5� 3 .,f.�• Z 7 TH T�A"�'� <br /> C�7y G`�, vy(� STATE (�Q ZIP 7 ' <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC,#(REQUIRED): ����1"G Z Z��`' CITY QF EVERETT BUSINESS L(C.#(REQUIRED)!.S'�'�Z (� <br /> PRI[�IIARY CON7AC?:��OWNER� � CONTRACTOR L7 OTHER{Please Specify) <br /> CONTACT NAME: CONTACT PHOME: �" � ZQ! OT� Z <br /> , ` "G ��^�/12�!'�� CONTACT EMAIL: �V I���� Zj�1.(�C�L.-Fi�T/e'LG� . � <br /> AGREEMENT.•T hereby certify that l have read and examined this applicafion and knowthe same to be true and correct. AI1 provisions oflaws and ordinances governing this <br /> type of woik willbe completed whetherspecified herein or not. The granting of a permif does nof presume to give authorify to violate or cance!the provisions of any otherstate or <br /> locallawregulating consfruction or the performance of construction. Thaf I am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Lav✓18.27 RCW and 296.20o WAG. <br /> City of Everett Officia/Use Only <br /> FEE <br /> ��� �_ <br /> PERMiT# <br /> z-zt -� � � 1�02 � ��2 <br /> Owner/Au g nt Si ure Date (Revised 90/92/2015) <br />