|
�� i�L��C�1��Q�Q� pC�.�v�i �`� u,u�u�LOC�/��'�O�q
<br /> ���
<br /> � C1TY OF EVERETT PERMIT SERVICES
<br /> ��,,.,���i-r?G��-
<br /> �� 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-88�0 � FAX 425-2�7-8857 � (E) everetteps@everettwa.gov � www.everettvva.gov/permits
<br /> ,.
<br /> ,
<br /> PI���CC��i' �D�i[� �V@�G�nOL'�GI�Q�i d�OG�11:
<br /> , . .: . :,... : . _
<br /> ,. .
<br /> _ .
<br /> � ,� _
<br /> PROJECTADDRESS. -',�` {/ '�% �'i��'-'� �: ���-� � �',-• �-/�-' ,:���� �
<br /> � =
<br /> BUILD]P1G AREA(if residentiai, new consfruction, remodel, or addition) SF
<br /> BUILDING TYPE: ❑ SFR-DETACHLD ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: '�COMMERCIAL
<br /> -�) .
<br /> USE OF Bl11LDING: ,�-y�;. „' ,� -- -- —.
<br /> _ —_ ._
<br /> _
<br /> C�f���`PI�OC���,l�PPL D��li DO�' Qf��oO�Gi�L�I`I�����
<br /> �:--
<br /> CONTRACT PRICE OF WORY: $ " = ���
<br /> f`=/ '
<br /> �IUMBER OF DE1lICE� (ifi low voltage):•
<br /> FIRE ALAR@II? ❑YES C�1V0
<br /> ASSOCIATED BUIL.DIIVG PERiUIIT#(if applicable):
<br /> DESCRIPT(OW OF 11VORFC: �� -' �,.�-� - T��:.��-'5��;-i;�� (.; .. -�7� i� ,��1 � ���� ,_��r
<br /> , � � .
<br /> I•'ilc,1�°' Lr_� ��<_ .�� .- _ ,� r'r_:� �a�> ..�:�c' _� �i
<br /> _ .. _,-... , ..
<br /> .
<br /> . _
<br /> G�A9`�',�C`�' 01�9�����'�'���'_ _
<br /> _ . � .� ;.
<br /> OWNER NAME: 1%.- n� _-,; �= -,-;��� TENANT NAME(lf Commercial):�!��';% fz x�'� Sr i�i,�!F- .
<br /> OWNER MAILING ADDRESS: sr�eEr
<br /> CIiY STA7E ZIP
<br /> OWNER PHONE:� ? -,� 3 � %� �f OWNER EPVIAIL:
<br /> ._ . _.. . . ,, ... ,. _:...: , ., .._, , . _, .. . ...
<br /> CONTRACTOR NAME: /;f y ` ��/�` I l�f.--�� ,✓ ��
<br /> CONTRACTOR ADDRESS: STREEr /�X"�>%I �`�:r�'-y/ �=<'' �� �'� ( ✓
<br /> f i '''><,/ � i
<br /> �_1.!.= i-- CI1Y I!i(✓�� STA7E � P i����� ZIP �j�
<br /> � i: �"�
<br /> —� : `� ��i,,' i�� �' c T 1
<br /> COfVTRACTOR PHONE: `-r�� � �.� � '��.5" - CONTRACTOR EMAIL: /, ,i��c� i X;' + „�', �,;,-- i"
<br /> CONTRACTOR LIC.#(REQUIRED): �',,'i'�_�-'-,� �� ,.�`I T ; CITY OF EVERETT BUSINESS LIC.#(REQUIRE ): O (
<br /> .._._._..__ ... ._��_ . .._ _ _ ._. , . ,
<br /> PRtIVIARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAIVIE: CONTACT PHOME: `x?��'� � �=^ f`,��`-r; � .
<br /> /� y- �y�� .�,,.' ) - �
<br /> �1�}-t .>/,� L� COP�ITACT ElV1AIL: � , � _/7�C .r'G�Gz������ �::,- ��: �' „t�C%`'L�;'
<br /> AGREENENT.�T hereby certrfy that l have�ead and examined this application and lrnow the same to e ue and correcf. A!1 provisions oflaws and ordinances governing this
<br /> fype of worlt will be completed whether specifred herein o�not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other stafe or
<br /> locallaw regu/ating construction or fhe performance of construction. That!am aufhorized 6y the ownerof this property to perform the work for which application is made and(
<br /> comply with the State Contractors Law 98.27 RCW and 296200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> ' � \� .�O
<br /> PF_RM1T#
<br /> ! � � �' � �� � ���� " �� 1
<br /> �✓'� � �`J���� %/�� )`-� -
<br /> �
<br /> OwnerlA� oria "Agenf Signafcire Date (�evised 10/92/2095)
<br /> ;'%
<br /> ��
<br />
|