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���c������� ������ ����oc�,��oo� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> , �'63���C�`����'� 09��'����`�9�f�- _ <br /> PROJECT ADDRESS: � � ��-L� � �� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) �� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: C�IJ�(6') <br /> ��,E�`�'�BCAL A�'��v�/��'1O�d oi���R91i9/�l'90Id <br /> CONTRACT PRICE OF WORK: $ ' S L L�(�? <br /> NUMBER OF DEVICES(if low voltage): <br /> F1RE ALARM? ❑YES �J NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTIONOFWORK: � (��� L� C�1 � [ls�'�� `� CEi�-� ''JG'• I�Q-Qii>�c �� <br /> � C ►�C✓J"� ��'�-� +7�-i M,�� '_ !�'r X �Z . <br /> � <br /> �,�-:1 S�,J n%'�,(ii �, . W� S�J� 'r[L1 L��') l�'C't S ' )X�✓� � I <br /> Z r' i..���.,2 l. ,,�}-1, ��.''.�� . ,��M <br /> CONTACT INFORMATION , - - , <br /> OWNER NAME: V 1(�l �(�Qj i.� -�{�T�r,�`'�"�NANT NAME(If Commercial): ��(,,U►�'� �U��bf <br /> OWNER MAILING ADDRESS: srREEr <br /> CITY STATE ZIP <br /> OWNER PHONE: �ZS' Z 7�' �r�I�� OWNER EMAIL: <br /> CONTRACTOR NAME: � ?j Cy �-���C�'1�� <br /> CONTRACTORADDRESS: srReer Zs � I �h P L �rZ <br /> �U�'��i� ��Ty STATE � ZIP ���� <br /> CONTRACTOR PHONE: � 2� • � 1�-bQ��� CONTRACTOR EMAIL: ���� tU f� �l�-(�l�C • C���1 <br /> CONTRACTOR LIC.#(REqUIRED): �3��� 3�' -I S�'�LI CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D y J L(� �' <br /> ......: ,„_,,....,.. .:_:........ ....:...:. . . ...:.:.:: ._.... _...:,. .:...,.:,:. , ,.:...:,. _.. _..:. .:,:,.,,._ . �,. :,:.. ._..-_... . ._...,: �.,...-. _.,...._... <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR L�OTHER(Please Specify) �'�L,� � L��� ���It,I ��C� <br /> CONTACT NAME: CONTACT PHONE: � � - j s�f S f 0 Z <br /> , �QC�n r L/1 V�E-`�'�� CONTACT EMAIL: <br /> AGREEMENT.'T hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing this <br /> type of work will be comp/eted whefherspecified herern or nof The granting of a permit does not presume to give aufhority to vio/ate or cancel the provisions of any otherstate or <br /> loca!law regulating construcfion or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with fhe Sfate Contracfors Law 98.27 RCW and 296.200 WAC. <br /> City of Evereit Official Use Only <br /> FEE <br /> � I �� � `��1� <br /> PERMIT# <br /> i <br /> '' � � -ti� � l � J�� 2�l�' � i �C�? ' I D� <br /> Owner Aufhorized Agent Signature Date (Revised 10/92/2015) <br />