Laserfiche WebLink
�����N��,� ������ ���9��i�q���l <br /> CITY OF EVERETT PERMIT r.y--IICES <br /> 320Q GEDAR STREET, EVERETT, WA 9820'i <br /> (P)425-257-889 0 � FAX 42�-257-8857 ] (E)everetfieps@everettwa.gov) www.everetiwa.gov/permits <br /> � , .._. :.. .:.. . _- <br /> : .. <br /> . . P�iO.lEC7`�17'��N�ORi�I�,7'IO�tI . <br /> , .: <br /> �. __.. . ..,.. : ...:... ... .. . . ... . ....:... . ...... _ .....,.. - . .. .. _ .. ....... .. ........ . ... .. . ... . <br /> PROJECT ADDf2�SS: �� � �"' ��Y`2. �l �I�1� ��� <br /> BUILDING AREA(if residen#ial, new construction,remodel,or additian) SF `( 'f'�(, <br /> SU1LDiNG TYPE: CI SFR-DETACHED ❑SFR-ATi'ACHED ❑ DUPLEX Ll MULTf-FAMILY-#QF UNITS: COMMERCIAL <br /> USE O�BUILDING: '��`� <br /> . .` ELE�TAZMCAL ,APPLICe�7'ION INFORMATIOA'I <br /> ..:_. .:_..,.._ ...._.� .._�. � ,...., _, - - <br /> >_ .,., _ ..: . .. . :.. ..._.:. <br /> �.. _ . .. . .., :.. _�. ........ <br /> ._ . ...,. . .� .. ... . : ..:,: <br /> CONTRACT PRlCE OF WORK:� , <br /> NUMBER OF DEVIGES{ifi low voltage): � <br /> FIRE ALARM? ❑Y�S MO <br /> AS50ClATED BUILDING PERMIT#(if applicabie): <br /> DESCR[PTI�N OF WORK: <br /> � � <br /> S <br /> :.:�::.:.:::.. :... ,,.:. ,:...: - ..,,- �..:..-;�-_��.-::.• ;-:.._....,.:.;:::;.:. ...:. ...........�..:..__._.....__.:�..�__... .. _ �.. . ... .._. . _. . . _ - <br /> � __.....�. .. . <br /> = � � .:. . .::::CONTACT:I,NFORMATION�':;� ..�� �.�.: =:_�.s .. . <br /> OWNER NAME: � �'i • TENANT NAME(If Commercial): <br /> OWNHR MAILING A D ESS: srReEr � • �� <br /> .�— <br /> C�7y � STATE 3 ZIP <br /> OWNER PHONB: OWNER EMAIL: <br /> CONTRACTOR NAME: 1 I <br /> CONTRACTQ}2 ADDRESS; srnEEr y "O SVv � �� <br /> CIIY Y \ STATE ZIP� � <br /> CONTRACTOR PHONE: � <br /> a CONTRACTOR EMAIL� <br /> CONTRACTOR LIC.#(REQUIRED): � CITY OF EVERE7T BUSINESS L(C.#{REQUIRED): <br /> PRIMARY CONTAGT:���OWNER M�S.ONTRACTOR J��OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �j— � <br /> � <br /> � CONTAGT EMAIL- i C , <br /> AGREEMENT.�T h eby certify that l have read and examined this applicaSon and know the same to be true and cor�ect. All provisions of laws and ordinances goveming this <br /> fype of work will be omplefed whether specifred herein or not_ The granting of a permft does not presume to give authorify to violate or cancel the provisions of any other state or <br /> local(aw regulating construction ar the performance of consfruction. That/am authorized by the owner of this property to perform the work for which application is made and l <br /> comply wdh fhe Sfate Contractors Law 9827 RCW and 296200 WAC. <br /> City of Everett Offcial Use Only <br /> FEE <br /> � t��, �� <br /> PERMIT# <br /> � � t!C O�r��� <br /> owner/Authorized A ent Signature Dafe (Revised 90/92/2095) <br />