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Dec 1516 08:34a Vickie 6914838 p.1 <br /> L.�1�G ��0 6��-���S� � � <br /> �LE�TR���C. �ER���` �,PP 1�,�� - <br /> C�� <br /> CfIY OF EVERETT PERM[T SERUICES <br /> 3204 CEDAR STREET, EVERETT, WA�8207 <br /> (P)425-257-88�!0 � �'AX�2�-2�7-8857 � (E) eref#eps@�vereitwa.gov � www.evere�twa.gav/permits <br /> � YE 1�1�ORN3ATlQN <br /> PROJECTAF7DRE5S: �?/ ~ 1' � ���j�c� 1 <br /> 8UlLi3ING ARE4(if residenfiai, new consfn�ction, remodel, or addition) g� <br /> BUILI7WG"f'YPE: ❑ SFR-DEfACHED � SFR-A7TACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF ITI�II'S: '-t��OMMERCIAL <br /> USE OF 8LJ]LD1t�IC_ ��.� <br /> E RICAL PPLICATIOW II111FOiti MATION � <br /> C�NTRACT PR{CE OF WQRK:$ ��� <br /> NUMBER��DEVICES (if low voltag ): <br /> Flf���LARI1�{? ❑ YE5 ��O <br /> AS54C[ATED BU1LdING PERMIT#(if appiicable): <br /> DESCRIP7lOt�OF WQRft: " � c,—�..��Q� i��- �� /c�� � � .��, , <br /> ��1, C�-�--�v�- �u�c��s �.��-e� i..��.�-� - - <br /> . � �_�o.� � <br /> CON�'ACT INFClRMATION <br /> OWNER�IAME: ��� ' T�HANT NAME !f Commerelai): <br /> OWh{ER i1J1AlL{i`iG ADDftESS: s-��� <br /> cro srntE � <br /> OWfJER PHON�: OWNER EiVfAiL- <br /> . ._... _. _... ......... ...._....._ _ ....... .._ ._. ....._..._. . . . ......... .. . .. . . .. .. .. ... _ _ ... _ . ...--�- - <br /> .. . <br /> CON7RACTOR I�AME: �f ' 'C ��. . <br /> CQNTRACTOR ADDRESS: srnEEr �� <br /> �' "t� 'l.[.� L.� sra-rE �� z�F ! 'j�� <br /> C(7NTRACT012?HONE: � 1 1 � '(� J' (,� CONTRAC70R EMAIL: '�� � i �-y� Y1 ��+ (� c. <br /> CONLTRACTOR LIC.#(REQUjRE3�):��"� "r—1��3� C1TY OF E'VERETT BU51fVESS LIC.#�(REQ111 D): <br /> . .. . .. .. ... .. . . ...... .. ._.. ... .... . ........ ........_.(......._...........: .__........._.... .. .........._.._.-. ... .............._.. ....... ........._...._. <br /> PR[MARY CON3'ACT_ 0 pWNER j�-EOMRAC�OR C7 OTMER Please Specify) <br /> CO�1T T AtA�UIE: CONTACT PHONE: � .w�F��_ ��� <br /> V LC�' -'�-� • CONTACT EMAiL: ' � <br /> AGJ4EEMENT.•Thereby t�e�fi!'y that J have read and examrned fhis appGcaUon and knosa Fhe same Fo��frtre and correcf. Al/provisions afla►vs artd ardinances govem.ing fhis <br /> type af cvor�c vrill ba aompieted ivhelher spec'med herein orrtot The granfing oPa permiF doesr+ofipresume toqive authorily ta viofate or cancef the provisioosoFanyotherstate o� <br /> lvead 1aw regufating consfruction or tha perfor.mance of cor,stnrction. That!am author¢ed by fhe o�vner of fhrs prope�t}r to pedo�in the work ror�vhich applica!ion is made and I <br /> coma�y u�ith the State Confracfors Laia•iB27 RCWand296.200 VUAC. <br /> Cify of EverBtt fltficia!llse Only <br /> FEE <br /> � � 2 .SC� <br /> PERM[T# <br /> ��- C�� � �� - �'�-��., � E (,CoC 2. -�(.� <br /> Ownar/AuEhorized Agent Signature Dafe (fi'evised 90/12J<^015j <br />