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L <br /> � ECTRCL PER : 9PLICATION <br /> '�' r _ <br /> FT CITY OF EVERETT PERMIT JLRVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257•-8810 1 FAX 425--257-8857 1 (E) everetteps@evereftwa.gov j www.everettwagov/permits <br /> >a <br /> r , ( ryY s��1 5 <br /> w <br /> PROJECT ADDRESS: 2 ) 12. -7G/ 1:415/ 5t- <br /> BUILDING AREA(if residential, new construction,remodel,or addition) y4'0 SF <br /> BUILDING TYPE: El SFR-DETACHED 0 SFR-ATTACHED El DUPLEX El MULTI-FAMILY-It OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: o1�f< - <br /> r.-. p <br /> 1�ll�.li1JIA . ._.. <br /> CONTRACT PRICE OF WORK:$ <br /> Z 000. el <br /> NUMBER OF DEVICES (if low voltage); <br /> FIRE ALARM? 0 YES 121 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION.OF WORK: ,,,�' 1 t. /1 12 - &4( c'C/Vi`& 1 <br /> ,:ciyitNER.NAME; : M J, Ct ' FCt.cil, 1. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -6t 41€ <br /> CITY <br /> STATE ZIP <br /> OWNER PHONE: // t� : L 1 OWNER EMAIL: <. < , ._.. ...,, . _-.,.�,. ,W.. < .... ._.._.. �..u. <br /> CONTRACTOR NAME: ' , ._.�..2 c C!4'`C -.C16 u - <br /> CONTRACTOR ADDRESS: STREET P.0. .OXJ ZZ 7 7 <br /> CIT( 41.yh 4 u/cei / STATE (A// / f ZIP g'r- <br /> CONTRACTOR PHONE:A day . ifD/6 7 y ,CONTRACTOR EMAIL: 1k, e k C civic �! /�Oin,g i 7. C#' 1 / <br /> CONTRACTOR LIC;#(REQUIRED): ie t-/.�7!�b wn_">�•Q, CIN OF EVE/ 76 <br /> EVERETT BUSINESS LIC,#(REQUIRED):19g6/ <br /> PRIMARY CONTACT: El OWNER VW/CONTRACTOR EI OTHER(Please Specify) <br /> CONTACT NAME: 4.�vd�G,71 F, l CONTACT PHONE: ZD�'5`7' 4 J J . <br /> / CONTACT EMAIL: by h, ey,e10,7`G g (iota,/Cdr <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this <br /> type of work wi11 be completed whether specified herein ornot- The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction orthe performance of construction. That lam authorized by the owner of this propertyto perform the work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 00 <br /> iDO - - <br /> PERMIT# <br /> / 7/ 2 /' F OS- tgl y <br /> Omer/Authorized Aged=ignature Date (Revised 10/12/2015) <br />