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������c��� ��r���� � �a����o� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE�, WA 9820'I <br /> (P)425-257-8810 � FAX 425-257-88�7 � (E) everetteps@everetfwa.gov� www.everettwa.govlpermits <br /> _ <br /> . <br /> ���PFtOJE,��I' SI`f� 9NF06i�J1,�'�°'IOi� � <br /> _ <br /> PROJECTADDRESS: � ��'..(��- - ;�� �N ' f�, � <br /> BUILDING AREA{if residential,new consfruction,remodel, or addition) r� 1� SF ' <br /> BUILDING TYPE: ❑SFR-0ETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ' COMMERCIAL <br /> U5E OF BUfLDING �Gi N�it�w ����c3�� • <br /> _. _ : - .- <br /> _ <br /> : r;; ' ;.. . <br /> - . <br /> . s ELECTR�CAL.APP.L.ICA7'IOi�� ANFCiRMAT90Id _ <br /> CONTRACT PRICE OF WORK;'$ 7 v���� <br /> NUMBER OF DEVICES (ifi low v ); _ <br /> F1RE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable)_ � <br /> DESCRIPT[ON OF WORK: <br /> e� ��� F� �, b e L'�c ��s� �t � . <br /> �Z � � 0 � `�r� � Ci�r � <br /> .. ..: . . ... : - <br /> .. , . _ . . _ <br /> ` ' ,CONTACT,INFORMATION <br /> OWNER NAME: n;�iM-(kt;i�i TENANT NAME(If Commercial): 'j{�'� 1 G�� � � �� `� <br /> OWNER MAILING ADDRESS: s-raeEr �"I �I L) L�`� � E.�� - l e��`i �{;�v <br /> CRY ��GJ. STATE W T� ZIP � ��C <br /> OWNER PHONE: '�C�F ' ��'j`� - �`�,(�� OWNER EMAIL: ? <br /> CONTRACTO.R NAME: F(,1��,–ti� , � <br /> CONTRACTOR ADDRESS: s�eEr I�J 7 CO � 4 �,/ f� <br /> cilv MILI c 2_ srnre vl�� vP �c��2—___ - <br /> CONTRAGTOR PHONE: �}Lj - `j�j - ��p CONTRACTOR EMAIL: ' --� <br /> CONTRACTOR LIC.#(REQUIRED): IC f�I CL�(� CITY OF EVERETT BUSINESS L(C.#(REQ�IRED): <br /> ,,w�,..�.___ . ._,._ <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �.-�(2�- 3C�e�_ ,CG� � <br /> ��/�L ������ CONTAC7'EMAIL: <br /> M SP i � 1'7 � � G i-, LG�vt <br /> AGREEMENT.-T he�eby certify that I have read and examined this application and know the same to be true and co ect All provisions oflaws and ordinances governing this <br /> fype of work will be completed whether specifed herein or not. The gianfing of a permif does not presume to give aufhority to violate or cancel the provisions of any other sEate or <br /> local law regulating construction or fhe peiformance of construction. That!am authorized by fhe owner of this property to perform fhe work for which application is made and I <br /> comply with the State Coniractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Offcral Use Only <br /> FEE <br /> � ,�=� � - � � <br /> PERMIT# <br /> �lizti,,%�.� ��,r��z�-- ��G�� I �7 � �`���' � - ������ <br /> Owner/AuthorizedAgentSignature Dafe (Revised 90/12/2015) <br />