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LEC` RICAL PERMIT 4PUCATON <br /> CITY OF EVERETT PERMITMzRVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 ] (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED Q SFR ATTACHED ❑ DUPLEX MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> L: Ii FORM"011� <br /> CONTRACT PRIG OF WORK:$ Z <br /> NUMBER OF DEVICES (if low voltage). <br /> FIRE ALARM? YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> . r: <br /> • <br /> i'itFORMI#TlOiii <br /> C.T.[ <br /> A ..;,.>. <br /> Q3IVNER NAME;: ; TENANT NAME(if Commercial): <br /> fOWNER MAILING ADDRESS: STREET <br /> CRY STATE 7JP <br /> OWNER.PHONE: OWNER EMAIL• <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY ,,.Q STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT:m 0 OWNER ❑CONTRACTOR F1 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT.'Thereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances goveming this <br /> type of work will be completed whether specified herein ornot. The granting of a permit does not presume to give authorily to violate or cancellhe provisions of any other state or <br /> local law regulating construction orthe performance of construction. That/am authorized by the owner of this property to perform the work forwhich application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> City of Everest Official Use Only <br /> FEE <br /> PERMIT# <br /> _ mid E <br /> OuvnerlAutliorized Agent Signature Date (Revised 10112/2015) <br />