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. as�o.90 3 �a�9.� <br /> �LE�'TRI�,�� �ERtIlI�1' ,�a,PPL1C,�a�'�ON <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETf',WA 98201 <br /> (P)425-257-8810 � FAX 425 257-8857 � (E)everetteps@everettwa.gov� www.everettwa.govlpermits <br /> . _ ..o;,M•��T�O�� _ . _ ..�,.. . _ .: '. <br /> _ ..,:... .. •�.S TL� ..NR `-�: . <br /> . �P��OJ�4T .p ._�:..:�. ,.M;:`:�� _ ;'�h..:�::a, <br /> .......,,....._............<.. .. .. .. . <br /> .�. _..:�.; -- <br /> PROJECT ADDRESS: ;�J . <br /> BUILDING AREA{tf residential,new construction,rem I,or addition) S� <br /> BUILDING TYPE: ❑SFR-DETACHED CI SFR ATTACHED ❑DUPLEX Cl MUL71-FAMILY-#OF UNITS: �COMMERCIA! <br /> USE OF BUILDING: DE� G EVG� � <br /> - - . '�t� - �=ATiON�� ���' ;', - <br /> - • . ��TYON ���ORM '_�-::. .,:�:: <br /> ��EL��TRI�C L�AP��,I�A,,: .�1. .�s. :.,:�. _ - <br /> ';:`: :.,: ..�1.�.... ,-.. <br /> CONTRAC7 PRICE OF WORK:$ � <br /> NUMB�R�OF REVtCES if low voltage:• . <br /> FIR�ALARM? ❑Y6S NO <br /> ASSOCIATED BUILDiNC PERMIT#(if a Itcable: <br /> DESCRIPTION.OF WORK: . <br /> . <br /> •.<..Y. -�� - � � ; �. �� � - � • u�OI�TACT�IN�ORIV1AT10�1:.. . . .. _. . �. . . . :�_. . _' <br /> .:; . ;t. _ �•. �. <br /> OWNER NAME• � TENAM'NAME(If Commerclal: <br /> OWNER MAILING ADDRESS: srneEr P7iUX J <br /> C� �� �A�Wi4 �I IZ -Z2.�7 <br /> OWNER PHONE: OWNER EIVIAIL: . <br /> CONTRACTQR NAME' G� � � <br /> CONTRACTOR ApDRESS: �E� Pa $�x . �j <br /> CITY � IG V� STATE�/�/�1 Z1P GL/ <br /> CONTRACTORPHQNE: 'Z 7'' `i'?' CONTRACTOR�NlAIL: /Q'/E�. A��rR j � C�� <br /> CONTRACTOR L(C.#(REQUIRED: ��N� �TD Z CITY OF EVERETT�USINESS LIC,#(REQUIRED): O <br /> PRIMARY CONrACT: ❑OWNER @I CONTRACTOR ❑OTHER(Pleass Speclfy) <br /> CONTAC7NAME: CONTACTPHONE: Z�-73b"(pS`� . <br /> , �CNNIr'J C�U�AI CONTACTEMAIL: D� NtS.�.,'�Ol.il S ICI�'v►/'!T, L�.oIYI <br /> AOHEEMEN7 T hereby ce►Nfy that I have read end exemined thls applicetlon and know fhe same to be hue and crorrect All provklons oflaws and adlnances goveminq this <br /> (ype of work wOt be completed whe(hers�eclNed here/n ornot. 7he grdnHng ofa permlE doas not presume fo glvs authorlly to Wofate or cancel Ehe provisMns of any otherslate nr <br /> local/aw regulaNng construcUon or tha perlormance of construcNnn. That/am authorired by the owner of this pioperly to perfom�fhe work for whlch appllcaffon Is made and/ <br /> complywl(h ihe Sfate Conhactors Law 98.27 RCYVand 2962ov WAC <br /> City of Evetntt Ofllclal Use Only <br /> F� G?� <br /> � �/as� - <br /> PERMIT# <br /> - _ � E � �� ^ � zg <br /> � af <br /> Owner or zed Agen 3ignature Date (Revlsed 90/f212096) <br />