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_ 1�29a�:a8�o.59a ��y�� <br /> �L.��TR.9�A� ����VI�`� ,APPI��C,A�'9�� <br /> Cl`lY OF EVERETT PERMIT SERVICES <br /> 3200 CEQAR S7REET, EVERETT,WA 9820� <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetfwa.gov� www.everettwa.gov/permits <br /> ,...:_:..:.:.:.. .::. :..:... ... . _ -- - - - �.:- . _ - <br /> ,... :,...,,., <br /> ........ :. ... . . :..: ..•.: �-,:•."�. . ... . . . <br /> ,;:..,.. :. <br /> � . �PRO:DE4-Y��IT���9NFOI�fYlAT10� _ _ _ ���: <br /> PROJECT ADpF2ESS: 3'rj -� <br /> BUILDING AREA.(if residential,new construction, emodel,or addition) SF ' <br /> BUILDING 7YPE: ❑SFR DE7'ACHED ❑SFR-ATTACHED ❑pUPLFJC ❑MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: Q�� (� �✓�j�j� • <br /> r._ - . . _ _ - �_- - - -- _ 'O- -'FOIt1VIAT10A� �- - . -- - - <br /> . ..,..., . . <br /> ELEGTRIGi�,1;�Ai'PLICA�Y'1 ,pV^IXd _ _ <br /> _ - ��•� -- <br /> CONTRACT PRICE OF WORK:$ 0 ' <br /> NUMBER OF DEVICES(if low voltage):� � <br /> FIRE ALAi3M? ❑YES $�NO <br /> ASSOCIATED BUILDING PERMIT# if ap ifcabie: <br /> DESCRIPTION OF WORK: �I <br /> , `;,.� � � _ , . . . � . - . _ . . �COIi�'1'ACT`lNFOItiV1AT10N:� � � . .. . _. �-� . .. . : <br /> OWNER NAME: � TENANT NAME If Commerciai): � � <br /> OWNERMAILWGADDRESS: srn�r ,�OX ?j' <br /> �� L� �A�Wi9- vPG7 /2 -ZZa7 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTt2ACTOR NAME: /CJ C1�i IU� <br /> CONTRACTOR ADDRESS: srnEer l"U �DJC <br /> CfiY � IG STA7E�!(/�) ZIP � <br /> CON7RACTORPHONE: �j'Z 7'' �� CONTRAGTOREMAIL: A'/ef. /Y1�rR I �T. CD�) <br /> CON7RACTOR L[C.#(REQUIRED): ��N�/eC 'TO Z CITY OF EVER�TT BUSINESS L(C.#(REQUtRED):�O5 <br /> PRlMAftY CONTACT: ❑OWNER �IrCONTRACTOR ❑OTHER(Please Specify) <br /> CONTAGT NAM�: CONTACT PHONE: Z�-73 6"(p S`�-�p <br /> • ��N N�S C�aW CONTACT EMA1L: p� J�(Cj.c,eow� ki�,��r� �� <br /> AGREEh1EN7 T hereby cerNfy that 1 have read and examined thfs application and know the same to be tiue and correct All prov/slons oflaw.s and ord/nances goveming thls <br /> [ype of work w1/1 be compfeted whetherspec�ed hera/n or not Tl►e grenting of a pennit does not presume to ghre aufhorl4Y to v/olate or cancel the provlsions of any otherstate or <br /> kca/law regu/aBng constracUon or the performance of consGvctfon, Thaf I am autho�zed by the owner of thls properfy to perForm the work for whkh appllcatlon!s made and 1 <br /> comp(y Ivifh ihe State Confraclors Law 18.27 RCW aad 286.200 WAC. <br /> City of Everett Officlal Use ONy <br /> FE�. L� �!/��l/ <br /> ' PERMI7# <br /> _� _�� I� l�5- ��C� <br /> Owner u ar zed Agen Signature Date (Revised 10/9?J2095) <br />