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06/17/2016 FRI 14: 00 FAX 425 252 1666 CM Heating X003/003
<br /> AVECTRICAL PERMIT ALICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> OOL 3200 CEDAR STREET, EVERETT, WA 98201
<br /> � �rr �?11a(P)41I215-257-81810 FAX 425-257-8857 (E) everetteps@everettwa.gov wvwv,everettwa.gov/permits
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<br /> PROJECT ADDRUS: 1
<br /> BUILDING AREA If resldentlal, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: El SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK; $
<br /> NUMBER OF DEVICES If low volts a :
<br /> FIRE ALARM? ❑YES ❑ NO
<br /> ASSOCIATED BUILDING PERMIT#Qt a Ilcable :
<br /> DESCRIPTION OF WORK;
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<br /> OWNER NAME: TENANT NAME jif Commerclal :
<br /> OWNER MAILING ADDRESS:
<br /> CITY STATE Zip
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME::
<br /> CONTRACTOR AD13RESS: STREET
<br /> C ITy A STATE Z p
<br /> CONTRACTOR PHONES: �AsO�5 � { CONTRACTOR EMAIL: ` C'Y l t (�j
<br /> CONTRACTOR LIC.#(REQUIRED): VV0 1 CITY OF PVFRFTT BUSINESS LIC, REQUIRED : O
<br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: ( CONTACT PHONE: O .�
<br /> CONTACT EMAIL:
<br /> AUREEMENT:Thereby certify that I have read and examined f pl/cation and know the sOM9 to be true and corraof. All provislons of laws end ord ncss goveming this
<br /> type of work will be completed whetharspeolf/ed herein or not. The granting of a permit does not preaume to give authority to violate or cancel the provisions of any other$tete or
<br /> local law regulating conslrueflon or the performanos of constructlon. That/em authorized by the owner of this properly to perform the work for which application/s made and I
<br /> comply with the State Contractors Lew 18.27 RCW @nd 296,200 WAC,
<br /> City of Everett ONlclel U&@ Only
<br /> FE
<br /> i PERMIT#
<br /> Owner/Authorized Agent Signature Date (Revised 10112/2015)
<br />
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