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, , —..... —._ rn. -•�.---�- `y-vd� <br /> ���������� ��II�A�A� ������ u ��� <br /> C(TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q'I <br /> (P}425-257-8810 � FAX 425 257-8857 � (E)everetteps@evereftwa.gov J www.everetfwa.gov/permits <br /> :.,.,_.,...,... .... ::::•... .. . - - -- -- - _ . <br /> -::��;.. :. .... . . ; .._�- . q /��¢ �+ �p+ ysa /� / -n . . � . . . <br /> _;:�-�::-.;�:�-•: p�/ <br /> r +�.�,';�- <br /> . ; .-, .. .. . .. . . .. :'.'�..�� _ . . <br /> ..- <br /> . .. • .... ... ... •.. ..._...: � ::.� �lO��\i`�;.uT�l�`YY■���IY/t'#�l�,V�a;� - <br /> .. . .�. . �. - <br /> - .� - .;i.. -n.. - - - :a. <br /> ...........i-.._.......�...�.....:.. �.�. ....... ..:. ......:......:-�....... :....�...:...:.-_..� :. .. -.:.... .. ...•_�:.. . .....o-:: ' ' - <br /> . ..�. . .. ...... ... ......... . :__ . .. . .. ...,_ <br /> PROJECT AppR6SS: �� LDG (�-��/v �"�O <br /> BUILDING AREA(if residenfial,new construction,remodel,or addition) SF ' <br /> BUILDiNG TYPE: L7 SFR DETACHED ❑SFR ATTACHED ❑bUPLEX L7 MULTI-FAMII.Y-#OFUNITS: �COMMERCIAL <br /> USE OF BUILDING: ����G EV�TT� ' ' <br /> . . . . . '1." " _ _ ' _ _' ' - ' " ' - ' . _ <br /> �E�ECTRI�AL APPLO�AYION^I��FOIt1VIATlOi�i� - <br /> , .. .. .... . . <br /> �1. - <br /> ._,:.. . . ��. . .. - <br /> :::.�i...��. .'�...:_�.�.�.� •.�. :.�: ..�: '..:�. -•._�..�. � .l":...�� .yL'....: � _ <br /> CONTRACT PRICE OF WORK:$ � • <br /> NUMBER OF DEVICES(ifi low voltage)t� <br /> FiRE ALARM? ❑YES NO <br /> ASSOCiATED BUILDING PERMIT# if applicable : <br /> DESCRIPTfON OF WORK: � � <br /> �`�' ��,. ;z.. � � ' � - � �.,C;OMTACT�INFOR171i4T10N:':. . . .. . _. - �-� . .. _ ._',:.., - <br /> .:3 <br /> OWNER NAME: � 7ENAN7 NAME(If Commercial): �� �j <br /> OWNER MAILING AQDRESS: srn�r ,�OX ?j <br /> CITY L� 3TA'C� Yy/' 7JF�/ IZ "��d� <br /> OWN�R PHONE: OWNER EMAIL: � <br /> CONTRACTQR NAME: �UY �L� / /� <br /> CONTRACTOR ADDRESS: srneEr Pa 8ox <br /> �� !� /G � �A�1/'� �P 2 <br /> CONTRACTOR PHONE: �j' "Z �'[� `7'� CONTttACTOREMAIL: �'/ef. /I�}�rR l /r� CD�I <br /> CONTRACTOR LIC.#(REQUIRED): (.3�N� ?D Z CITY OF�VER�TT BUSINESS I.IC.#(RE4UIRED):(}LIO <br /> PRIMARY CONTACT: ❑OWNER �IYCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTAC7 PHON�: ��-73 b"lQ 57'�p <br /> . 1)�'N N I 5 Ci2d U l coNracr Enn,art,: D�Iy1�!S.Cr'KOW� 1:1�"vt/'�T. �IYI <br /> AGREEMENT.�T hereby cerfify that l have read and examined thls applicatlon and know the same to be true and correct All provlslons oflaw.s a�d ordtnances govemtng th7s <br /> type of work wlll be complefed whather specified herein ornot. The granting of a pe�mit does not presume to glve aufhorlly to violate or cance/the provislons of any otherstate or <br /> local(aw regu/af/ng canstructlon or the perfaimance of construdlon. That/am aulhorized 6y the owner of thls property to perfarm the work for whlch appllcallon is made and/ <br /> comp(y�ith the Sfate Conhactors Law 98.27 RCW and 296 200 WAC <br /> City ofEvelett OHIcJaI Use Only <br /> . FEE � oa <br /> � �9� <br /> PEftMIT# <br /> _a_� E i � o � ,�I� <br /> Owner Au or zed Agen Slgnature Date (Revised 10/12/2015) <br />