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C�C�`��BC��i� �C�G��i a`� ,;=����'���Q`�0�[� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> _ - ����➢��'� �9l'L� �I�G���61��`�9�1�` _ _ _ <br /> PROJECTADDRESS: ��(�S� .j�u'- • S/Yl�[ v� ' 1fk( �Ir2/ v �C� <br /> BUILDING AREA(if residential, new construction, remodel, or addition)_� 'C�i SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#k OF UNITS: �OMMERCIAL <br /> USE OF BUILDING: ��;�n � `��� l'��I� ��L� ffi <br /> ��,EC�'R9�AL A�'��,ICt�`�IOId 9R���Ri1i1a�7'90�d <br /> CONTRACT PRICE OF WORK: $ ( � ` <br /> NUMBER OF DEVICES(if low voltage): <br /> F1RE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Q �'a 5 ) L!P � � �'� ' <br /> / - �liij l /�7 <br /> CONTACT 7NFORMATION : <br /> OWNER NAME: a v� �,� C�J`(� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer <br /> C�7y STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> _,... <br /> _.. <br /> CONTRACTOR NAME: c�VVl.O� ��G�i n � 1 _ <br /> CONTRACTORADDRESS: sTR er � ,[� NLC J Gc l <br /> CITY �� ) VI.C' STATE /T ZIP ��Z,Z3 <br /> CONTRACTOR PHONE: '� 7 Sd —?j CONTRACTOR EMAIL:U1Ci�I YVLctY�1 y-��SY140� ' r�i��C� Q.G�IC..�c-�'• <br /> CONTRACTOR LIC.#(REQUIRED):5 j'j/�D k �� � CITY OF'EVERETT BUSINESS LIC.#(REQUIRED):�� �, <br /> .._.,_...._.. . _ <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L��� a'j� --3C— ' � <br /> (�� n���� CONTACTEMAIL: � , �l,Gyyj�k� L nit�� 1� <br /> /�"l <br /> AGREEMENT.'T hereby certify that 1 have read and examined this application and know the same to be true and correcf AlI provisions of/aws a ordinances governing thrs <br /> type of work will be completed whether specifred herein or nof The granting of a permif does not presume to give aufhority to violate or cancel the provisions of any other stafe or <br /> loca!law regulating construction or the perfo�mance of construction. That l am aufhorized By the owner of this property to perform the work for which applrcatinn is made and 1 <br /> comply with the State Contracfors Lav✓18.27 RCW and 296200 WqC. <br /> Cify of Everett Officia,�Use Only <br /> FEE <br /> � 2�� ,4a� <br /> � \ ` PERMIT# <br /> ����r ` 3 � � � � � � ' � �'� <br /> Owner/Authorized Agenf Sig ture Dafe (Revised 10/12/2015) <br />