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�����r�a��� ��i��uo� ����o�a�o�� <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 /> _ _ <br /> �R�J��`� �i�`�'I� 9Fd����l�1i��'➢�6�1 : <br /> PRQJECT ADDRESS: �� � �� . L�? �/X�j�� <br /> BUILDING AREA{if residential, new cortstruction, remodel, or addition) SF <br /> BUILDIIVG TYPE: B SFR-DETACHED ❑ SFR-ATTACf�ED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDIfVG: <br /> �_ <br /> EL,EI�TROCa4L A�P��CA�'I�Rd It+1�O121VIB�7'��Id <br /> CONTRACT PRICE OF WORK:$ � G: '" <br /> NUMBER OF DEVICES (if low voltage): r <br /> FIRE ALARM? ❑YES Ja M0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTfON OF WORK: ���� _ �'�CC'/1VF•�' ' � �- S�� <br /> CONTACT 7NFORMATION <br /> OWNER NAME: �� I 5 f�<(� �� F'�"l� !P =''llt TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srrteEr n � � � � F <br /> p�7y - STATE (�%� � ZIP <br /> OWNER PHONE: �;� �- ' '��� OWNER EMAIL: <br /> CONTRACTOR NAME: Q���L' � EC /" �� <br /> CONTRACTOR ADDRESS: srReEr � H� , S /- S L� <br /> �/ � <br /> CITY � �.?/� -J//C"� STATE ZIP - <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL; �° /��- C' ,/�' j _ �/'�q=' <br /> � � �� 7� � CITY OF EVERE T BUSINESS LIC.#(REQUIRED):�-��.5�/"-� <br /> CONTRACTOR L[C.#(REQUIRED): � ' /f <br /> .. ,__..... _.�.., r.._.. ..�. .. .. __ ..., . .. <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ;� � <br /> : , , ' v CONTACT EMAIL: -- � , / l'i? � - �,� <br /> AGREEMENT.T hereby ertify fhaf I have r and examined this application and know the same to be true and co ecf. All provisions oflaws and ordinances governing this <br /> iype of work will be completed whether s�ied herein or not The granting of a permit does not presume to give autho�ity to violate or cancel the provisfons of any otherstate or <br /> local law regulating construction or the p rformance of construction. That!am authorized by the ownerof this property to perform the work for which application is made and I <br /> comply wrfh the State Contractors Law 98.77 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �I� � <br /> ^ y � <br /> �� <br /> .� <br /> , <br /> � i�'% PERMIT# <br /> �-� /; �- r <br /> r, � ���.i /� ��� �2.' I �� <br /> Ow Authorized Agent Signature ate (Revised 10/12/2095) <br />