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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98209
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: j �j 4 .. �� I - (., .+. �( - � ',�.;,� �_�
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) ;'��.c_ �; �(.�c�«G���SF
<br /> BUILDING TYPE: � SFR-DETACHED �}SFR-ATI�ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELEC"9'R��s4�, ArP�La�A1T0�� 0�➢�O�i�1A`�"90� 3
<br /> CQNTRACT PRICE OF WORFC:$
<br /> NUMBER OF DEVICES (if low voltage): ------- ._._
<br /> FIRE ALARM? �YES ❑ NO �y
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): . ;- �';� ' - `` ` � �
<br /> DESCRIPTI�N OF WORtC: "�c� �-{, f� ;c � �U' i� � � '_ � V�,,=�v � L.,�r i .t'c' 7
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<br /> ' CONTACT INFORMATION ,
<br /> OWNER NAME: �z; -., , / ��,•� ; �,,; .�;, - < i �.►TENANT NAME(If Commerciaf):
<br /> OWNER MAILING ADDRESS: s-raeEr
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<br /> J -�. �7 C�.<^a�.�� I '�v'Wr11tY ''� L�. ,��Gy��� STATE L�4�' i`► ZIP �"� C� �
<br /> OWNER PHONE: � ,,G �'j; _ __ -�z� ,I• �� 5 OWNER EMAIL: ck �.-- �:.Y i.0 . " ��cl�c �� � '�r�J .��� [�c�.��
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<br /> CONTRACTOR NAME: ' ��'��-��'�' �"-^ c, `,t� i ��
<br /> CONTRACTOR ADDRESS: sTReEr � '
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<br /> CIN ;'j�'-,�� = % STATE t-.g,,.%!�- ZIP t�,s''�'L--G> >
<br /> CONTRACTOR PHONE: �;;.G� ' � S`'I"7 CONTRACTOR EMAIL:
<br /> CONTRACTOR LfC.#(REQUIRED): CITY OF EVERETT BUSWESS LIC.#(REQUIRED):
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<br /> PRIMARY CONTACT: �3`OWNER I�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: GONTACT PHONE: ,. � �_�" 4,_'" ``�'G� -- r� " � �j '
<br /> ,. 7 �L• �� , � �'� CONTACT EMAIL: � � -� "?� � ).--(,
<br /> .�..�.� �c r- G'� � c:.l�4 �` x l.t._L% � �G �) �7 j� )'1/11�.i
<br /> AGREEMENT T hereby certify that I have read and examined thrs application and know the same to be true and correct. All provisions oflaws and ordrnances governing this
<br /> type of work will be completed whether specified herern or nof The granting of a permit does not presume fo give authority to violate or cancel the provisions of any other state or
<br /> local lav✓regulafing construction or fhe performance of construction. That I am authorized by the owner of this prope�ty to perform the work for which application is made and I
<br /> comply with the State Contractors Law 98.27 RCW and 296200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE _�
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<br /> °Owner/Aukhorized Agent Signature Datc� �r (h'evised 90/12/2095)
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