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06/05/'2006 06: 11 2532E82�56 GARNER ELECTR� PAGE e4i'68
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<br /> �., CITY O�' �V�RETT PFFZfVIIT SFRVICES
<br /> b� 3200 CED/��Z S`T'h'�ET, E\/�RCTT, 1NA�0201
<br /> (P) 425-257-�810 � FA>C�25�257�8�57 � (�) everetteps@everettwa.gov � v�/vvvv.�verettv��a,gov/permits
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<br /> PROJECT ADbl��'SS: Q�� V
<br /> F3UILIDING�R�A(i�F resitlentlal, ncvu construc#ion, rcmodel,or sddU:ion), _ 5�
<br /> BUILDING TYp�: � SFR�D�`I'ACI-lCb ❑ 5rR-ATFACHED � DUPLEX MULTI��Allllll-Y-#��U�IITS:�� ❑COMMCf�CIAL
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<br /> GQNTACT.I�IFORMA�`M'�C'��1
<br /> OWNER NAME: C` " %�" TENANT NAME(If GommercEal :
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<br /> OWNIER PHONE: =, �.-� �,_ , - OWN�R�Ml�l�:
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<br /> GONTRAC70R NAEVI�: ' �
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<br /> CONTRACTOR ADDRESS: 2Tt�s�r "' r r �1 � \
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<br /> CoNTh'�CTOR PE�IONE: ' �,. . -rf'�- ;�- � '�^' CONTRACTO EMAIL' �c ' %�� �1 I`� ` � L'.0��
<br /> CONTRACTOR LIG.#(I�L"-QUIRF_I?): C1TY 0�FV�R�TT BU51NE55 LIC,�f(RF{1UIREb):�j,C,_" ,�, �
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<br /> PRIIIltA1�Y CON7'ACT: ❑OWNER �_GON7FtACTQR 0 OTI-IFR(Pfease 5pocify)
<br /> CO TACT NAME: CONTqCT PhIONE: ` __C���� -� �`',�r�
<br /> �Q�� CONT�C7�MAII,: �, � , ��� � - i)�,
<br /> <IGJ�EF_MENT,�T hereby certify thet/h�lie�P,9d end OX�mlli�d thls epplfceflar�arld knaw f(�e seme fo be tYue and oof'reCi, All plov/,slons of/aWs Bqd o!'dfl73n,Es govemin�7 ih(s
<br /> type of work will be compietetl wl�afkcr sper,If+ed horcln or n��, The grer,t,hg of e permit dves nof presclm�to grVo authol'(ty fo vloJete or cancel fAG provls(r,ns of er,y other 5tafo or
<br /> loca!!aw regu/afing consfYllctiD»ar fhr pPrformanco Of Constnfcfion. That I em eufhorized 6y the oWnel'of(ltis property to pe�orm the wodc�or whlclJ 9ppllcRtlon�s mado and!
<br /> compty ivitb the State Contractors Law 1�,27 RCW 9nd�ps.?_00 WAC.
<br /> Clfy of Everett Ot�rc;9�Usr Only
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<br /> Owner/Aufhorized Glgent Sign�tG1'� Dale (l�cvlsCd i0/17./7.09�)
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