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��E�T'RI�AL PER�1T ��LICATI�[�
<br /> CiTY OF EVERET� pERMiT SER'VICES
<br /> 3200 C�DAR STREET, EVC�ETi, ��A 8g201
<br /> {P;425-257-881Q ; FAX�2�-257-885? ; lE) e��ere�eps@evere�tw�.gov; www.everetft��.�.aov/permi�s
<br /> PR�JE�'�' Si'i`E 1N�C)RMA�`IOPi
<br /> PROJEC7ADDRESS: � " l �,T ���`}� �� ����;
<br /> BUILDiNG AREA(r res'der;i21. =v;Const;uCi cn. m ;;�; '" ;) SF
<br /> re o , or a�'dit�or
<br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-A�P.CH=� ❑ DUPLEX ❑ Pr?ULTI-FA:�11i�Y-��r UN!TS: C01�.?h�iERCIP._
<br /> USE OF BUiLD1NG:
<br /> ELECTRICAI. A�PlECATIUAJ INFO#tMATiON
<br /> GONTRACT PRICE OF WORK: $ ��j��.�=
<br /> NUMBER OF DEVtCES (if low voitaae):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDlNG PERMI'f#�rif applicabl�):
<br /> DESCR(PT10N 4F WOf2K: `� �4L� Z �-I 1 t �.#�'.. «,.}a{� L�3� 2 t�`���� .
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<br /> CONTACT INFORM/�1TION
<br /> OWNER NAME: i�����-L.:z tt� �;��� ��: TENAt�T NAME tf Commercial):
<br /> OWNEft MAiL;NG ADDftESS: ;:�_�,
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<br /> OWh'ER PHONE: QWNEF2 EMAfL:
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<br /> CONTRACTOR NAME: �� �,(�(.�^t�
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<br /> CONTRACTORADDRESS: s;a�C, ' '''j-� ' ''�r�� �
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<br /> CONTRACTOR PHONE: 2t(;; -'-f,7�;� j 7�;C: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.��REGU�RED; U c-C�GL.i��{'Z�+°��
<br /> ----. --�-_. .._�._ CITY OF EVERETT BU�lNESS LIC.#(R�CU;R�D): � '-F'f�f
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<br /> PR(MARY CONTACT: G CVVNER -- - —_� . .-- -_,.__..
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<br /> CON;RF,CTOR ❑0'fHER(P(SflSE Sp�Cifyj
<br /> CONTACT NAME: CQNTACT PHONE: Z�j�,_ �S�R�3 �
<br /> �S�%�V ��e�'�..a�,�,z���, GO�iTAGT EN(AIL• ` .
<br /> ' :�,.]����,lP �i7`��ic.+w•�7�� �, �.��.CGt�-�
<br /> k,�'-,REcM_�VT:T'r,e�ecy cer:'t,�y;n2i!h2ve;cad and sx�m?�Aa chis 2,�,ai,ca�o,�ar.a rros�r tF,e..ame.o�e irue and correct L;ii�
<br /> ` s rav.�sPons�i lav�s and ord::;ances gcvami�o i�fs
<br /> �fp=o��,or.;v,�i!!be c�,r,p!=ted«7e�her soecined hereln cr r,a�. The g,�zr,irrg o!a p�rm,'t dc�s rot presume to aive au�ority to violate or cance;ths provisicns c-�r,,i other s:ate or
<br /> 1oc211a;v reg�-2vng consf:zc6"en ar�he psr�cr,Tar,ce cf con.sfruc<';'or•. T':at 12m 2�f;�orized by t.^=ou-ner cf t'r.is proper�y;o c>.rtcrm��e siorr,;or r;:vc'r,ap,2rica';�,^;'s r-ade�rd!
<br /> co,np'ry�rith t,�;e S:ate Cor.'2c!crs La:�?8.27�GLV ard 29E.2p��lq�.
<br /> C'�OfE+Je2:'t Gi7`��%8I GSc 0;7/y
<br /> FEE �'
<br /> �,°l2 - � �
<br /> PERMIT#
<br /> --�" C� � 5 � 1� E 1 �-p � — ���
<br /> 0' neriAuihoriaed genf Signa,ure D�a� '
<br /> '4edsed 10/1?J20?5,)
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