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06�'05i'2e06 06: 11 25�22�2156 G�RNER ELECTRIC PAGE a�r'02
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<br /> C1TY O� �V�RI�TT P�I�MIT S�[�VIC�S
<br /> ..��' � 3200 CED�f� 571��CT, EV�I?CTT, 1�IA 9820�
<br /> (P) 425�257-SS10 � FA>C 4�25-257-8857 � (�) everetteps@e��erettwa.go�� � v�r/�w•everetiv���,gov/permits
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<br /> F'ROJ�CT ADDRESS: .
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<br /> BUILDI�iC AR�A(If fesidcntiaf, tlew const'ruction, remodcl, or addition) 5F
<br /> BUILDING TYPE: ❑ SFR�DGT/1CF�IED I� SFR�A'rTAC!-11=D ❑ DUPL�X MULTI-FAMIl,Y�#�F UNITS:,,�Q_ ❑ caMn�r-_r�ci�L
<br /> U5E OF BUILDING: „ _.
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<br /> COB�1S'fZACT PEZI�E O�11VORK: .'"p r �� '�, ' ,�
<br /> �lU�!lfBER OF D1�y�C�S if Eow voltaqe :
<br /> FIRC r4Ll�IR�11i? ❑YIGS `1�0
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<br /> pI�SC&�IF''�lON OF 11lJOkiK:
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<br /> , COhIT�1�T IN�ORM,AT�Q.�
<br /> 01NN�R N,�IIlI�: . , . . . .:. .
<br /> � °-pr•l ' 7�NA�I1"N,�IM�(ff Corrtmcrcial):
<br /> oWN�R MAfLING AhDR� srRFzr � � - `�kl `�. �? '-"., '� 1 l .
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<br /> OWNER PHONE: ' �� r�_ OWN�fi�MA1�:
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<br /> CONTRACTOR ADDRESS: �rl�F�'r � - � � �� �. 0 t � �, 4� �j
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<br /> CONTRAGTOR PHONE: ` �� , i3 �..- CONT�ACTOR�11�7A11.: h� � -• ;�� '_2 ��. , . (�..U�
<br /> CON7I�ACTOR l,fC.3#R�QUIRE : �� � � CITY OP EVERET7�USINCSS LIG.#(f�L"-QUIRF_D)=����,� �
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<br /> PRIMARY CONTACT: rI pWNER �CONTR/�CTOR l�OTH�I�(f�lease opeCify)
<br /> Cp.�(,7�CT NAM�: �ONTAC7 pHON�: `� ..�CC�'°�� - �„2`���
<br /> ����� �. GONTACT EMAIL: r ` � .� ��; � �
<br /> ACRC�MCN7';7 hereby certliy N�et I heve m�d sr�d examrned Phle�ppllcat(on�nd Irnoyr ll�e same to br,tr��e And corrocf. Al!provls(orrs oflAws 9nd ordlnanccs r�nvPrning fhis
<br /> rypo of worir wlll he r,olnpleted wl�ether spocffled hersin or noL '1'he g�antln.q of 9 pem7lt does nPt presume to give autMo�flyi to vlo(flle nr r,ence!tlto provlslons of Any othor sf�to or
<br /> loca/law regulath7.q.r,orrstructfor+or rHe porfonnanr.e of eonsiructlon, Th�t I am�ufhnrized by the owi,er nf tnfs proper(y(o��erform fhp work ror wl�ieh appll.?tloR Is made and I
<br /> Comply wlth the Sl,9fe Ca�itrar,fors Labv 18,2712CbV end 2�76,200 W�1C,
<br /> CitV of�em(t Otfir.ial Uso Only
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<br /> OwnoNAuthorir.r,d Ag�nQ SygnetLtr� D�te (l�ovlscd i0/12/i095)
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