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TA 0 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> ROJECT SITE [IMFORMATIOM' <br /> PROJECT ADDRESS: {tQ Q(Z VGCe—t--L L ffiqbo-3 <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: 9 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> -- [ELECTRICAL APPLoOATIOM INFORmAyiom <br /> CONTRACT PRICE OF WORK:$ 500. v o 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 4�110 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: PI'5eamswe ,pkv f <br /> CONTACT INFORMATION <br /> OWNER NAME: t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> crrY "tle io�L.( STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED) <br /> _. ._�.....�.�.,....r. �..�,...... .. ... ......:.........: u.. n...,,.._.u__...__. _,...... _..,.. W,._. _.._.� ._. _, ..w. . <br /> PRIMARY CONTACT: ]..OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> 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 <br /> type of work will be completed whether specked herein or not. 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 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> l � <br /> PERMIT# 4-10 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212095) <br />