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LL CC TROCAL pCRMT A03LI1CA ION CITY OF EVERETT PERMIT SERVICES. 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov j www.everettwa.gov/permits ONFORMATI PROJECT ADDRESS: L GAT og--i BUILDING AREA (if residential, new construction, remodel, or addition) /'�� SF �kBUI,LDING TYPE: ElSFR-DETACHED ❑ SFR ATTACHED ElDUPLEX ❑ MULTI -FAMILY - # OF UNITS: ElCOMMERCIAL OF BUILDING: CONTRACT PRICE OF WORK: $ Gy, C 9< NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES ly NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: Wire % lkltLS t-• TW�� all�[G�®RMATION OWNER NAME: �t' �- (,� TENANT NAME (if Commercial): OWNER MAILING ADDRESS: STREET My STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: C / S CONTRACTOR ADDRESS: STREET 7D 7�> ✓�' �yy Cny 5 Ir6 oef- STATE ZIP ` • CONTRACTOR PHONE: �;- ��(f -L� 4 v CONTRACTOR EMAIL: — -- CONTRACTOR LIC. #(REQUIRED): -dSTilr'/��/ �� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5 . 50 PRIMARY CONTACT: ❑ OWNER w_�.. CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: j 7 `,cc, b (--( r ]CONTACT CONTACT PHONE: EMAIL: AGREEMENT.- Thereby certify that/ have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any otherstate or local law regulating construction or the performance of construction. That/ am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW aad 296 200 WAC Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE ) o0 PERMIT# � 05� (Revised 1011212015)