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������8��� ����8� ���'���Q�O�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (�) everetteps@everettwa.gov� www.everettwa.gov/permits <br /> _. ������� �a�� a������,���� ` _ <br /> PROJECT ADDRESS: � ' � � ,—i'C'.� � ''I \i \ r ; ':r � �V � L7 � 1 <br /> BUILD]NG ARE (if residential, ew construction, remodel, or addition) SF <br /> BUILDING TYPE: S R-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: �, _�; <�� <br /> ���c�-��c�,�����oc�rso� ar��o��n�Tao� <br /> CONTRACI"PRICE OF WORK: $ 1 U <br /> NUMBER OF DEVICES (ifi low voltage): <br /> FIRE ALARM? ❑YES �.�IdO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> QESCR(PTION OF WORK: GLC�cI I 1 C V ' T'C_: �� �c� � <br /> CONTACT INFORMATION <br /> . . _ <br /> OWNER NAME: _..�E,�c-�--��' ' �I � S ' ENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�EEr � <br /> CfTY STATE ZIP <br /> OWNER PHONE: '�. I � �j �I� l�j��� OWNER EMAIL: � I � I �, � or, C,l���Y <br /> CONTRACTOR„ ,. _:.... .. ..., . . ... . .. .... <br /> NAME: , �✓\�ti � ti� % '� '�C.�t'�. \ <br /> CONTRACTOR ADDRESS: sTReeT I � 5 � <br /> C�7y r, STATE V V � ZIP V��v <br /> CONTRACTOR PHONE: ���- � � �j �3 �CONTRACTOR EMAIL: --.y � ,3 ��� y� �;-z ti I ?��Y��L,LC f'�� <br /> GONTRACTOR LIC.#(REc1UIRED): '��� , � (;� G- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): . <br /> PRIMARY CONTACT: ❑OWNER i CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �I 2'j C��3 ��� � -�7 <br /> �--v.` - CON7ACT EMAIL: ��,,,�b ��,,,� ; ,�C <br /> =�G "'�'1 � � .� (C,v`�C.�� E'�<[_ h���_ -,�^�. <br /> AGREEMENT.'T hereby certify that I have ead and examined this application and know the same to be true and correct. AI!provisions oflaws and ordinances governing this <br /> type of work will be completed whefher specified herein or not. The granting of a permit does not presume to give authority to violate or cance!the provisions of any otherstate or <br /> locallaw regulating constructioR or the performance of construction. Thaf l am authorized by the ownerof this properfy to perform the work for which application is made and I <br /> comply with the State Contracfors Law 18.27 RCW and 296.200 WqC. <br /> City of Evereit Officia!Use Only <br /> FEE <br /> . �'���/�� <br /> PERMIT# <br /> � <br /> �� �� � � i� - ► � � �� D I �'��J <br /> Owner Authorized Agent Signaf re Date (Revised 10/92/2015) <br />