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������.���� ����Q� ����8������ <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> , _ _ PR��)E�'�' SI'1'E �M���iViA7"ION � , . _ <br /> PROJECT ADDRESS: �-�j� r�- 2_} � � U 'y <br /> BUILDING AREA(if residential, new construction, remodel, or addition)���V SF <br /> BUILDING TYPE: ❑SFR-DETACHED I�SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: `�t� <br /> _ _ . <br /> ELECTRIC,f�L APPLIG�►T'IOF�H IY�lFORMAYION <br /> CONTRACT PRICE OF WORK: $ �7C;� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASS�CIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTlON OF WORK: '� -- - ,�''S� . �^1� �t,'- �� S ( <br /> ' :. CONTACT INFORMATION . <br /> OWNER NAME: � j�:�C.- `1_Q TENANT NAME(lf Commercial): <br /> OWNER MAILING ADDRESS: sTRe�r <br /> CfTY STATE ZIP <br /> OWNER PHONE � �L 5 �(��(�, Z, rL�� OWNER EMAIL: <br /> CONTRACTOR NAME: �,� .f'�f�f�\ fi % '�L� �� <br /> CONTRACTOR ADDRESS: sTReEr � l � � ,�� <br /> CITY ���PJ���d STATE � ZIP � � , C.� <br /> CONTRACTOR PHONE: Z� � �� CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): '�pJ'� �� ( ��1(a 1�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):b�� (,.� ; <br /> PRIMARY CONTACT: �-aWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: �L j "L��C�l �L�I? '� <br /> J� ����.,��J ' <br /> CONTACT EMAIL: <br /> AGf2EEMENT. T hereby certify that 1 have read and examined this application and know the same to be true and correcf. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specifred herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That l am authorized 6y the owner of this properfy to pertorm the work for which application is made and l <br /> comply with the Stafe Contractors Law>t3.?7 RCW and 296.20o WAC. <br /> City of Everett Official Use On/y <br /> FEE <br /> � <br /> PERMIT# <br /> ��-�.� r�n�3k�:,�a � ,ti��� � �� � ����"Jui <br /> Owner/AuthorizedAgentSignature Date (Revised 10/>2/2015) <br />