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02i23I2016 23 : 09 #0025 P. 001;'001 <br /> �EGTRiCAI� PERMIIT APP�ICATION <br /> CITY OF EV�RETT P�RMIT SERVICES <br /> 3200 CEDAR STRE�7, EVEREIT,WA 98201 <br /> (p)q.2�-257-$810 � FAX�25-257-8857 � (E)ever�tteps@everettwa.gov� wwvw_everettw'a_gov/pem�its <br /> PRo.��CT s�T� IN�o�e�NA�1oN <br /> PRC).1�CT ADDR�SS: � ,Z 2 �d n I� � <br /> Bllll.l]lNG ARFA(if r9isidgntiaf.new conshuCtiUn.remodel,or addidon) SF <br /> BUlLptNG TYP�: ❑SFR-DE7ACH�D ❑SFR-A7TACHED ❑pIJPLEX ❑MULTI-FAMILY-#oF UNITS: _ ❑COMMERCIAL <br /> USE oF 6LilED1Nc: <br /> ' CLEC7"RtCJ��.`APP.�:I�ATi�I+I`iMFORMATION <br /> CONTRACT PRICE OF WORK:S Sd0! <br /> NUM6ER OF D�VICES if low vo{t2� e : <br /> F��a�aiM� o Y�s ❑No <br /> ASSOCIAT�P BUILf]1NG PERMIT�i if$ kicable : <br /> p�SCRIPTiON OF WaRK: 1\ .�'^'M. M .� � � <br /> � � � ° <br /> � � o � � <br /> CONTAGT 1N�ORMATION <br /> OWN�R N/1AAE: 1'�NANT�IAMI� If Cammerciak: <br /> OWAf�R M.AfI-!NG AApRESS: srr��r '� � �•c� <br /> �,� ��� :+� z� 3 <br /> OWN�R PMONE: .� �' QWNER E�AAIL: <br /> carrrrta�raR ru�E: � ��L F1� / <br /> CANTRAC"fAR ADDRESS: srR�r t�� <br /> CRY 5?ATE � ZIP <br /> CONTRACTOR PHON�: � i co�nw►croR��ua�_ <br /> CONTRAGTOR LIC-i�(REQUIREQ): �-/fAI.S�S z CITY pF EVERETT aUSlNESS l.1C.�(R�quiR�D)Q�G�l <br /> PRIMARY CQNTACT: ❑OWiJ�R ,S'�dNTRACTOR I�OTHER(Please Specify) <br /> GONTACT NAME: i CONTACT PHONE: Z�� � 2 � <br /> � �'�/r/�� i cot�ac�'��uu�.:5�i E�'���1t� �P- C <br /> AGREEMENT T hen9Dy csni/y that I heve reacl arld ez�minaQ Ihis applJcatia>anQ knoW NA same to ha hue and co�.Y. AN p�lns�onS of laws entl oMitlances govBming this <br /> type ol work wi!!bm oompleted whsther�pecifre4 irerefn or noG The grer�Gng ol a pam�it doos rrot presume to giva�utRaity to vrolate or cancel tRe provrsiort�af aRy o1Aer state or <br /> local k,w regWating conshtixtlar w the pcROmiencb af��struttlon. rl+at f am autAMxerl by the owner of this propa�to perlWm tHe w�lfc fw which nppllcetlon is medo and! <br /> oomp(y Wdh the Sfate Canfrarlors Law i S.ZY RCW and 29@30D WAC. <br /> Ci(1/of�varatt 011itie!Uae only <br /> F�E <br /> � � �I:� <br /> ✓ <br /> PERMIT# <br /> � i i' '� `- � � I� <br /> � o� ' ';��,'��. <br /> arM ori�d Asant Siynatura pate (Revised 1n/!2/201SJ <br />