|
I������Q��� ����o� �������o��
<br /> CiTY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STR�ET, EVERETT, WA 98209
<br /> (P)425-257-88�0 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> ,. , _ ., :..,.. . , ,.. ..... �.: . ._. .......
<br /> . ..... :..:...:.
<br /> _,_:._.v...� . _. . :.
<br /> : .. . .. , ..: .:.�R�JEd��'��`➢'�.dI���R��`�'1�N:._:��.� .. :.::.. . .:. .� � ..
<br /> _,. : ...... :. .. . .. .. ... . .._ ... _ . . _
<br /> PROJEC7 ADDRESS: � � ` � ���J' � C:�#.
<br /> BUILDING AREA(if residential,new construction, remodel, or addition) SF '
<br /> BUILDING'TYPE: ❑SFR-DETACHED ❑5FR-ATTACHED ❑DUPLEX QMULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING; ��/ _ �
<br /> _. .. .. , _. ... ... ... .: : ...: .:.....:...�.........:...•-.:....
<br /> :�_ ..,_....... .... . . .::.,. :
<br /> ,,..,
<br /> .: :. ELEC'f'1�dl�A�,AI'P�,�C�'TIOI� IId�082�VIE1,7"I�I� �: .,�
<br /> :.. :.. . .... ... ..:. ..: .. . .: .. . . .. . .. .. . .. r.
<br /> ...: .. , .... ... _:. .. :.... . ..-- - � -
<br /> . .._..
<br /> COidTRAGT PRICE OF WORK:$ C� �"' �l� � �i C�c3
<br /> NUMBER OF DEVICES(if Iow voltage):�
<br />• FIRE ALARM? ❑YES NO
<br /> ASSOClATED BUILAING PERM17#(if applicable):
<br /> DESCR[PTI�Id OF WORK: � , � ,r F $
<br /> ��" � �; T `� �- � �l�1��� � .
<br /> �_:--- -:_ . ... . . .. . . . . . .. . .:.. ... ...:.. . :....... ... ..: . . .. .... . ... _. . - . .. _ -
<br /> . .
<br /> .._.._ . . _ . .. .. :
<br /> _:::_:_-:: : . - _
<br /> . :�°,: ,:CONYACT:INFORMATLON. :.:_ ... :
<br /> OWNER NAMP: ' f TENANT NAME(ifi Commerciai):
<br /> OWNER MAILING ADDRESS: srReer / �,�°^ �� , 1
<br /> ��� ��7y STATE ZfP ( �
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRAC70.R.NAME: S� `�^ P �
<br /> CONTRACTOR ADDRESS: s-rReEr � �� / ���
<br /> p�7y STATE ' ZIP �
<br /> CONTftACTOR PH�NE: � CONTRACTOR EMAIL:� � ;� � e �,� �
<br /> CONTRACTOR LIC.#{REQUIRED}: �� CITY OF EVE�ET7 US(NESS LIC,#(REQUIRED).
<br /> �.-�...u.,..__.a.-..__.,,..��._�r...,,....,�......,.s,.-.,��.-�.,. T....��,.....,,r.�,.,.,�.,W.�,_..x>...,:�,.,..�-.._,-,���................�.,.,�.,.,.....:..._-.�,_�....y__ - - _ - - -
<br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT MAN1E: CONTACT PHOIdE: �� -� �..
<br /> �� CONTAC7 EMAIL: � • � ,
<br /> AGREEMENT.�T hereby certify tha l have read and examined this applicaSon and know the same to be true a orrect AI!provisions oflaws and ordinances governing this
<br /> type of work wili be complefed whether speci�ed herein or�ot. The granting of a permit does nof presume fo g�ve aufhority to violate or cance!the provisions of any other state or
<br /> local law regulating consfruction 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!
<br /> comply with the Sfate Contracfors Law 98.27 RCW aad 296 200 WFlC, '
<br /> ' City of Everetf Official Use Onty
<br /> FEE
<br /> . �s � �
<br /> PERMIT#
<br /> ,
<br /> � �I ��` � �'�� ' � ��
<br /> Owner fiorize Agent Signature Date (Revised 90/12/2095)
<br />
|