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�����r����� ����o� ��'�������� � <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'1 <br /> (P)425-257-88�0 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov� www.everettwa.govlpermits <br /> , .. . ,. _ ,... ... <br /> . ,_.�.._..... . : •. <br /> .,. �` � <br /> _ : ._ . �R��E��i'�n�� 9N��RM�`�'8�9'�;:<_. , ..::: ::�� ... '. .. <br /> .. . . ... <br /> . ,. . ._..-. .. <br /> _ . : <br /> PROJECT ADDRESS: �� ` ' u � '"" <br /> � ���� i . i � <br /> BU(LD11UG AREA{if residentiai,new consfruction,remodel, or addifion) �o � SF � <br /> BUILDING TYPE: ❑SFR-DE7ACHED ❑SFR ATl-ACHED ❑DUPLEX Cl MULTf-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OP BUILDING: ( o �- ` � <br /> -- ;.. . .: . , .....:. ... ..:..:..... ..-.........: : - .. -...., :.., , .- <br /> _.._ .. <br /> . ... El�.EC'�'RAC�,�.�1PI���CA'g'109� Ai��OI��Vf1�'1'�0�1 . <br /> COIdTRACT PRICE OF WORK:$ � <br /> AIUM�ER OF DEVICES(ifi fow voltage);• � <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPT[Otd OF WORK: �V� 1 <br /> ._:�:- ._:. . .._ . .. � -. _ - - - . . .... . _. -. -, _.. - - <br /> .,.:...: . _.. � . _ . <br /> . . . . . ... ::... . .:: .._ .. ... ... .. .... .. ... . . : <br /> . ,. . . <br /> , .. . <br /> .. . . � . . .. ..:: :. ... .. ::..� .;CONTACT:lNFORMATION.:,:._ . _ _ _ <br /> OWNER NAME: TENANT NAME(If Commercia!): <br /> OWNER MAILING ADDRESS: srneEr <br /> ��d� ���5 fl ,p� <br /> CITY !.�S/�(�� � ' STAT6 � ZIP �, � V •. <br /> OWNER PHONE: OWNER EMAIL: <br /> r <br /> CONTE2ACTOR NAME: " �,,►', � <br /> CONTRACTOR ADDRESS: srReEr � <br /> f� . <br /> CIN 'ryE,�' Q STATE ZIP ���' <br /> CONTRACTOR PHONE: `JeQ �' .� � CONTRACTOR EMAIL: t � � j i'�°� : CU�h <br /> CONTRACTOR LIC.#(REQUIRED): ��d"c�C,.��� O� 1 �_. CITY OF EVERETT BUS(NESS LIC.#(REQUIRED): ������ <br /> PRIMARY CONTAGT:� ❑OWNER�M ��CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT►VAN1E: GONTACT PHONE: � , a �E •- � f` <br /> < � � ` � CONTACT EMAIL: � �"��� . � e� �,� '�"' �, CO�h <br /> AGREEMENT.-T hereby cerfi that/hav read and examined fhis application and knowfhe same to be rue and correct. A!1 provisions�flaws and ordinances governing this <br /> fype of work willbe completed whether specified herein or not. The granSng of a permif does not presume to give authorify to vio/afe or cancel the provisions of any otherstate or <br /> loca!law regulaSng construction or the performance of construction. That 1 am authorized by the ownerof this property to perform the work for which application is made and! <br /> comply with the Shate Contractors Law 98.27 RCYV and 296 200 WAC � <br /> ' City of Everett Officia/Use Only <br /> FEE <br /> ' �� �� <br /> f <br /> r7 PERMIT# <br /> � � <br /> � � 1� �1 �� � �.�l�M t z-9 <br /> OwnedAut orized Agent gnafure Dafe (Revrsed 90/12/2095) <br />