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<br /> CITY OF EVERETT PERMIT SERVICES.
<br /> 3200 CEDAR STR�ET, EVER.ETT, VIfA 9820'1
<br /> (P)�}25-257-88'10 � FAX 425-257-8857 � (E)evere�teps@evereftwa.gov� www.everettwa.govJpermits
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<br /> PROJEGT ADDRESS: � �G
<br /> BiJILDIIUG AREA(if residen#ial,new consfruction,remodel, or addition) � � SF �
<br /> BUILDING TYPE: ❑SFR DETACHED ❑SFR-ATl"ACHED ❑ DUPLEX Cl MULT!-FAMILY-#OF UNITS: COMMEFZCIAL
<br /> USE OF BUILDING: • '
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<br /> COI�TRA,CT PRICE OF I�JOR�C:$ . i9 O '
<br /> RIUfVIBER�F DEVlC�S(ifi low voltage);• �j
<br /> FIRE.ALARIVI? ❑YES O .
<br /> ASSOCIATED BUfLDI�IG PERiVfIT#(f applicable):
<br /> DESCRiPTI�N OF li4TORK; Z -' 7�+� -� �
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<br /> OWNER NAME: ' �TENANT NAME(If Commercial): �� "Pi�� �
<br /> OINNER MAILIP7G ADDRESS: s-nz�r
<br /> crTv srn-re vP
<br /> �WNER PHONE: OWNER EMAIL:
<br /> CONTRAC70R NAME: , �
<br /> C�NTRACTOR ADDRESS: srReer �' �
<br /> CIIY wj�(`�d�� STATE ZIP D (
<br /> CONTRACTOR PHONE 2,� -- � ONTRACTOR EMAIL: Q (,� s
<br /> CON7'RACTOR LIC,#{REQUIRED): Q CITY OP EVERET7 BUSIIVESS LIC.#(REQUIftED):
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<br /> PRINIARY CONTAC7; C]OWNER �EO�ITRAC70R ❑OTHER(Please Specify)
<br /> CONTACT NAM�: CONTACT Pi-IOME: �� � — �7 l
<br /> < � � � �� CONTACT ENtAiL:
<br /> AGREEMENT T hereby certify fhaf I have read nd examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing this
<br /> fype of work wili be completed whether specified herern or not. The granting of a permit does not presume to give authorify fo violate or cancel the provisions of any otherstate or
<br /> locallawregulafing construction orthe perFormance ofconstruction. That!am authorized bythe ownerofthis properlyto perform the workfor which application is made and I
<br /> comply with fhe Stafe Contractors Latv 98.27 RCVI/and 296200 WAC. .
<br /> ' City of Everett Officia!Use On1y
<br /> FEE
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<br /> PERIUIIT#
<br /> :0 05 ?,Di�. � �� �� " �"l �
<br /> . Owner rized Agent Signature Dafe (Revised 90/12/2095)
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