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i/ L1CAL PERMIT APICATION
<br /> -, CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERE cave W
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> s: t �N k $y 1"! heir I 400 0IG II NF#R 'i ID C / `. X 31 i i.
<br /> PROJECT ADDRESS: 5-3I2 Z3 A`4-Y" &f-e-4'- "" 9
<br /> '- 3 418 095f
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE:, SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: PQ4dC _
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<br /> CONTRACT PRICE OF WORK:$ `32.5700
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES M NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable : n g4I � -�ir
<br /> DESCRIPTION OF WORK: �i 12.44-4—LS tPLz LrSN. 2 /cv
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<br /> OWNER NAME: ZriN Mkofr‘. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDR SS: STREET 5) ) 23S°( „f ,-,),
<br /> CITY a(.44— STATE L✓i- zip 9,9zo)
<br /> OWNER PHONE: 42= ii( 0951 OWNER EMAIL:
<br /> �,,.,,. E ..,,ms,µ,,,:, , ,.,.,.,, .,. •, � , ,.
<br /> CONTRACTOR NAME: Cisco Electric, Inc
<br /> CONTRACTOR ADDRESS: STREET 22612 92nd Ave W
<br /> CITY Edmonds STATE WA ZIP 98020
<br /> CONTRACTOR PHONE:360-618-3038 CONTRACTOR EMAIL: maria@ciscoelectric.com
<br /> CONTRACTOR LIC.#(REQUIRED): CISCOEI914DE CITY OF EVERETT BUSINESS LIC.#(REQUIRED):042432
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 360-618-3038
<br /> Maria Nicodemus/Cisco CONTACT EMAIL:maria@ciscoelectric.com
<br /> AGREEMENT:I 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 type
<br /> of work will be completed whether specified 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 I 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 /> PERMIT#
<br /> �' / 4i, 3-13-lee E i 25d 3.e-07(AO
<br /> Owner/Authorized Ag:it t Signature Date (Revised 923/2016)
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