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���������� ����a� ����Q���oo� <br /> C1TY 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.everettvua.gov/permits <br /> �R����'�° �0�'� �����GlF���9�� _ _ <br /> _ <br /> PROJECT ADDRESS: j I� Li.�M P��I��l �VC:, , l� ��l-l�(; ( � Vl;�r-t C, �LJ� <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: /��� �` e � <br /> ���c��ao�������ac��ao� u��o��n;�rao� <br /> CONTRACT PRICE OF WORK: $ OO- � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ,�NO <br /> ASSOCIATED BUfLDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ��`�I f}�(�� /�/� �� (C -I' 0�4 TLC� ��(��1� <br /> , Q � � � - /� � - �o QC (.�Sc I� Fl�.F' <br /> ���c r�� � c � c� - <br /> CONTACT 7NFORMATION ` <br /> OWNER NAME: ( ��-f �,/ ����v TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer '�I J G-C�/� .C"_'��� /-����: <br /> CITY l.- V C/\� � I STATE �! l ZIP C�O �CJ � <br /> OWNER PHONE: � � 3 V�"��O� OWNER EMAIL: <br /> CONTRACTOR NAME: � - L�' <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY STATE ZIP <br /> CON7RACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT. T he�eby certi(y that I have read and examined this application and know the same to be frue and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whetherspecified herein or nof The granting of a permif does not presume to give authority to violate or cancel the provisions of any other sfafe or <br /> local law regulating const�uction or the performance of consfruction. That!am aufhorized by the owner of this property to perform the work for which application is made and! <br /> comply with the Sfate Confractors Law 98.27 RCW and 296200 WAC. <br /> Crty of Evereit Otficial Use Only <br /> FEE <br /> � � �1� , °� <br /> PERMIT# <br /> f <br /> ����/ �%►.��i� l�� �,� � � � � — �� � <br /> OwnedAuthorized Agent Signature Date � (Revised 90/92/2015) <br />