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�L.����.0��� ������ �-�l�"�fl������ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-88'10 � FAX 425-257-8857 j (E)everetteps@evereftwa.gov� wv,rw.everetfwa.gov/permits <br /> . :.. --. . ;. _ . ,.. . .. ._..., _.: . .. �....:. ...:... .,_._. . .._ . . - <br /> �.Fr� . .. . ,. . �.:.. _ ......:..::_ <br /> ... <br /> - � ��� I������`�' �0`�'I� �I���RM�`�'g��';:° `.:.. .''� <br /> PROJECT ADDRESS: �j!'O M ( w Ic� <br /> BUILDING AREA(if residential,new construction,remodel,or a dition) � SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED � DUPLEX ❑MULTI-�AMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: �.�;� � � • <br /> ,., ., :. . . . . .. , .. ..... : .....:. ..... :.. . .. . . ..... ....: .: �.:-., .,.. <br /> , . :. .�-. - -.. . .: . .....:... . <br /> , .. .. , <br /> � � `�'�_ A�;a4����C�'��0� ������A`����. :: .._._::..: .:: .: . . ..::. . <br /> CONTRACT PRICE OF VVORK:$ �po aP � <br /> fdUMBER OF QEVICES(ifi low vo(ta );� <br /> FIREALARM? YES �u�.�rc�l � Vt�e�. � �nni �'-�'i OQu�� <br /> ASSOCIATED BUILD1iVG PERMIT#�(if applicable): v�owQ� <br /> DESCRiPTiON oF WORK: c�t, (fL �,v� i�,�o �.�a��e�r ti ��,re. a��w� <br /> � a, G�v� <br /> � <br /> .,..:�-: - .,: ... . . . ........ .: . . .�.:_ C�O�T',AC . .. . _. . - .. . . <br /> :;....._ _. . . , = - <br /> _.. . . . <br /> .. ... ...:..:_ . . _ .. . .. .: <br /> � � � � , .T INFORMATION. :._ <br /> _::. .•:... :. . .. _ - . � - - <br /> � -- . <br /> _ . .. .. .. ....,_;N. <br /> OWNER NAME: p '�,u�, ev� �ro TENANT NAME(If Commercial): �� <br /> OWNER MAILING ADDRESS: s-rReEr �bC� S� � I�QI(W ZO <br /> CITY � STA7E W� 71P -{(�(N� <br /> OWNER PHONE: �j- pQ OWNER EMA(L: <br /> CONTRACTOR NAME: � M �i�2G�i2G <br /> CONTRACTOR ADDRESS: sra�Er ?j 2j OO �.�� S� 77D�j <br /> ciTv �(,t 6( V' srnre tJl!{� ziP Z. <br /> CONTRACTORPHONE:(��{ � s�(-( OZ CONTRACTOREMA(L: M�7PAKK 'll1 `Q'OL <br /> CONTRACTOR LIC.#{REQUIRED): p/1�(-�l�ir[a7 ( CITY�F EVERET'f BUSWESS LIC.#(REQUtRED:pS`IS 3 <br /> PRIMARY CONTAGT:w L7 OWNER u M NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:M 4� �a p�� CONTACT PHONE: L f u- �' _ �G��Z <br /> < CONT,4CT EMAIL: MSP k l'7 OL c GOt/I� <br /> AGREEMENT.'T hereby cerfify that 1 have read and examined thrs application and know the same to be true an correct Al!provisions of laws and ordinances governing this <br /> fype of work wi!l be completed whether specified herein or not. The granting of a permit does nof presume to give authori[y fo violate or cancel the provisions of any other sfate or <br /> Jocal/aw regu/ating construction or the performance of construction. That/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✓98.27 RCINand 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �� m'/ <br /> PERMIT# <br /> .'I��� u�r„s�- -Z3-lB � ����' '"" ��� <br /> Owner/AuthorizedAgentSignafure Date (Revised 90/92/2095) <br />