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0 , 2-712 ► a
<br /> y '' 4 ELECTS`ICAO_ IIT APPLICATION
<br /> = CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-2578810 j FAX 425-257-8857 j (E)everetteps@everettwa.gov www.everettwa.gov/perrrtits
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<br /> PROJECT ADDRESS: L) ;Z.Li :1�..1 elt..l 06l UY y tn, " .
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF •
<br /> BUILDING TYPE: ❑SFR-DETACHED A SFR ATTACHED ©DUPLEX Ia MULTI-FAMILY..#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: go -1I 4 , AVE
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<br /> CONTRACT PRICE OF WORK:$ Lj [ o Q
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(If applicable):
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<br /> DESCRIPTION OF WORK: —7 .
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<br /> OWNER NAME: TENANT NAME(If Commercial): BCE/A.)6
<br /> OWNER MAILING ADDRESS: STREET po ,&ox 3707 ,/
<br /> CITY J501i 771.E STATE W/1- 4�d�/24"2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: �. /J&A1"L, _A),57 /V.:1 0/0
<br /> CONTRACTOR ADDRESS: STREET Po z7o�x41
<br /> CRY mag/L.7rc9 STATE�p A- ZIP 982D L�
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<br /> CONTRACTOR PHONE;.�zrj"297"6q`f"4 ,'CfONTRACTOR EMAIL: /��'/�j. H , Coin
<br /> CONTRACTOR LIC.#(REQUIRED): 6EA.18 t 41 O�l�7'U z CITY OF EVERETT I USINESS LIC.#(REQUIRED):�o
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<br /> PRIMARY CONTACT; U OWNER Ili CONTRACTOR �CI OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206-73 to- 654Lp
<br /> I) N I4 t 5 CeDuti CONTACT EMAIL: D INIS.e gow 4 kIEw'1 T. &)M
<br /> AGREEMENT:T hereby certify that 1 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 worst will be 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 siate 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 application is made and I
<br /> comply with the State Contractors Law 18.27 ROW and 298.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE I
<br /> PERMIT#
<br /> 5-25 E iqm (Qt
<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2015)
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