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c�ECTFt[CAL PERMIT ARpLICATICIN
<br /> G1TY OF EV�RETT PERMIT SERVICES
<br /> 32fl� GEDAR STREET, EVERETT, WA 98201
<br /> {P}425-257-8810 � FAX 425-257-8851 ( (E)everetteps@everetiwa:gov{. www.everettwa.gov/perrnits
<br /> PR�.�EiCT 51TE �NEE)RMA7iON
<br /> �ao�e�cr aoa�z�ss: ���� ,�.''a��.�-�, �` : ; �, ,
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<br /> SUlLDING AREA(if residentiai, new construction,remodei,or additio�} gF
<br /> BUILDING TYPE: ❑SFR-DETACHEO ❑SFR-ATTACHED ❑DUPLEX O MULTI-FAMILY-#OF UNITS: � COMMERCIAL
<br /> USE OF BUIL�tNG: �`�,��,������ ��� � . ��s_� �
<br /> ELECTRtCAL APPLICATI�N INFORMATION
<br /> GONTRACT PRtCE OF WORK:$�� �,P-�t,,1
<br /> NUMBER OF DEVICES{if low voita eg:
<br /> FIRE ALARM? ❑YES NO
<br /> A5SOCIATED BUiLDING PERMIT#(if a piicabte):
<br /> QESCRIPTION F W�RK: F"'°' �
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<br /> CONTACT INFORNtAT10N
<br /> {SWNER NAME: �-��;,}�� i;y , TENANT NAME(if Commerciaf: e '-�,�s'�,
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<br /> t]WNEf2 MAtLING AC1i�F2ESS: srReer �, `��` „�, ,+'��� .�+�;
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<br /> STATE Lr{,,,�f� /� qP �"'a)...
<br /> OWNER PHONE: G}WNER EMAIL:
<br /> CONTRACTOR NAME: 1'���/��`�: °'4'j ����;,.--?''��"'r G.,;�- L,�.�",�:t.'?���.�''e.r,,,�w� -,-�.�,°t��.„,
<br /> CQN7RACTORADDRESS: srREer �.�7,��„,�,,� °"��` �a"�"Cr`(;�,,, �'�
<br /> CITY ...,«?��='s�" ��.w STA7E `+i.''��" ZIP �_���.m'�i..„�•-•••—
<br /> CONTRACTOR PHflME+ ��" �• � -"��'r' �'"� ' eONTRACTOR EMAtL: /'�.�._ s'
<br /> � �!.•�l,`�i�''!�;" �5=��.�a,"R't a,.:'�5'a4 ,�:n1�.�
<br /> GONTRACTOR LIC,#{REQUlREDj: ����"����,,; ���'"�r C�Ty OF EVERETT$USINESS LIC,#(REC2UIRED):�,�� ��'�°r
<br /> PRlMARY GONTAG7: I�OWNER � ONTRACT(7R ❑C7THER(Piease Specify)
<br /> CQl+iTI�T'NAME: CUNTACT PHONE:„��, -�=��-,.--�..�°'��:
<br /> �-_:�p�������'�� G�NTACT EAAAtL• „�-p �,...
<br /> AG!?EEMEfv7"7 hereby cerhy that f have read and examined fhis applicat7orr and know tha same#o ba trve and correCt. R/I provisrons of Iaws and ordenances goveming tlrrs
<br /> fype of work wilf be complefed whetNer speCified he�eia or not. The granting of a permit does not pr�sume fo give aathority to violafe o�cancef the provisions of any ofher state or
<br /> iPcafJaw regulating construction o�the perfo�mar�ce of constrochon. 7haf t am authorized by the ourner of this property fo perform the wark for whiCta application is ntads and f
<br /> eomply with the Stata Contractors Law i8,27 RGWand 296.20o WAG.
<br /> City of EvereYt Offi'c.ial Use On1y
<br /> ; FEE ��
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<br /> � •- PERMIT#
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<br /> : `��'� �� /� E ( �O�- � ��
<br /> qwne uthpriz AgentSi ature Date (Revised 1Q/i712015)
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