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3 27a
<br /> ELECT' 9CAL PE PPLICATI•N
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 425-267-8857 (E)everetteps@everettwa.gov I www.everettwargavlpermits
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<br /> PROJECT ADDRESS: - dpie,f t/L,
<br /> BUILDING AREA(if residential,new construction,re odel or addition) SF '
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<br /> BUILDING TYPE: ❑SFR DETACHED El SFR ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: l COMMERCIAL
<br /> USE OF BUILDING: 0E1
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<br /> CONTRACT PRICE OF WORK:$ 1/ ' 70t • •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if ap licable):
<br /> DESCRIPTION OF WORK: � �� lJ'I�-/ 5�/O�f��� 4e 5z 4e
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<br /> ;.... . •j•] .. : • -. .;. . a. ••.r. ..GONT4CT INFORM)VrIIIOM:;.. '...
<br /> OWNER NAME: TENANT NAME(If Commercial): lN6
<br /> OWNER MAILING ADDRESS: STREET PO &Ox 5707 •
<br /> CITY ft5EkTTLE STATE rV4 sjpq,6I2//�/-2267
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: 2eVe t ( /05nel/t.-77 ),O
<br /> CONTRACTOR ADDRESS: STREET Pt BOX-41, p /� p+� L�j
<br /> crr, ✓/ ug iL.!G� STATTEV I/ LP/ 2Z5 L
<br /> CONTRACTOR PHONE:426-294-6944f �1 CONTRACTOR EMAIL: k4Ri. 144/101E-g&kl,}!j/i r' CD/n.
<br /> CONTRACTOR LIC.#(REQUIRED): C41$14Qrz CITY OF EVERETT BUSINESS LIC.#(REQUIRED):( a591�
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<br /> PRIMARY CONTACT: d OWNER 14 CONTRACTOR ❑OTHER(Please Specify) •
<br /> CONTACT NAME: CONTACT PHONE: 204,-7 3 6-%52/4,
<br /> . rD6NNIS t DUI/ CONTACT EMAIL: DEN N 1 S.6,got ( klk'14t1 T. L'.•OIYl
<br /> AGREEMENT:T hereby certify that!have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this
<br /> type of work will he completed whether specified 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 I am authorized by the owner of this property to perform the work for which epplication is made and!
<br /> comply with the State Contractors taw 18.27 RCW and 286.200 WAG
<br /> City of Everett Official Use Only
<br /> FEE
<br /> PERMIT#
<br /> - E 04 - ("A
<br /> OwneriAu f orized Agen Signature Date (Revised 10112/2015)
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