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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)42�-257-8890 ( FAX 425-257-8857 � {E) everefiteps@evere#twa.gov� www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: q •� ��
<br /> BUILDING AREA{if residential,new construction,remodel,or addition), ��� SF � g ��
<br /> BUILDIIVG TYPE: ❑SFR-QETACHED �-SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: �
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<br /> C�AITRAGT PRICE OF VYOR�'+;� ��4� .°= .
<br /> �dUMBER OF QEVICES(ifi low volfage):� �
<br /> FIRE AL,4RM? ❑YES NO
<br /> ASSC)CIAT'ED BUILAING PER1V11T#(if applicable):
<br /> DESCl2IPTIORI OF WORK: t Y �o s � Vld tJ �Vl l. I
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<br /> OWNER NAME: TENANT NAIVIE(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rEteer
<br /> CRy STATE ZIP �
<br /> OWNEl2 PHONE: OWNER EMAIL:
<br /> cONTRACTOR NAME: � �, rrv(,' N'�<
<br /> CONTRACTORADDRESS: I �, e 3 LS� l�..
<br /> ,e, 1,t9 � arr �,dJ J�" �O�Z 3 STATE ZIP
<br /> CONTRACTOR PHOME: Z� — S I" I � CONTRACTOR EMAIL: �l VD I.C"� -G'It,.G 1'L c> �C�
<br /> CONTRACTOR L[C.#(REQUIRED}; ���/ �/`C �CN GITY OF EVERETT BUSINESS LIC.#(REQUIRE
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<br /> PR[MARY CONTACT; ❑OWNER I�CONTRAGTOR L QTHER(Please Specify)
<br /> CO T/aCT[VAME: GONTACT PHONE: '2�Gi �-g�(� "'� t ;6
<br /> CONTAGT EiVIAIL:
<br /> AGREEMENT.�T hereby cerfify t at/have read and examined this appiication and know the same fo be true and correct. All provisions oflaws and ordinances goveming this
<br /> type of work will be completed whether specified herein ornot. The grantinq of a permit does not presume to give aufhorify to violate or cance!the provisions of any otherstate or
<br /> locaf law regu/ating construction or the performance of construction. Thaf/am authorized 6y the ownerof fhis properfy to perform fhe work for which application is made and 1
<br /> comply with the State Contractors Law 98.27 RCtNand 296.20o WAC.
<br /> City of Everett Offrcia!Use Only
<br /> , FEE
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<br /> PERMIT� �O� — ���
<br /> ���`�' ���� 1 �' �
<br /> OwneriAufhorized Agent Signature Date (Revised 10/92/2095)
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