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..LECT IC L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j (E)everetteps@everettwagov J www.everettwa.govlpermits <br /> PR a 4ICT, lli4F®RII0,A`IPIiN':` : <br /> PROJECT ADDRESS: 0015- jeAredreAt Alfrt <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> • IELECT' CAL <br /> CONTRACT PRICE OF WORK:$ WO <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> • DESCRIPTION OF WORK: l gign 1V,e • <br /> I too. -P � / 'of c <br /> t <br /> : - N CT;•INFORMATION- <br /> OWNER NAME: `IOU vl ', /T� ,�E�NANT NAME�(If Commercial): <br /> OWNER MAILING'ADDRESS: STREET 6°2/1 / [�, 2 &4 lO <br /> CIY ' STATEWA) ZIPqg'zioi <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:1 v l —�6 �1 <br /> • <br /> CONTACT EMAIL: val/c�/A i/I �'2 / ,/, Y�n',(`i��/W <br /> AGREEMENT:T hherreby certify that I have re..and examined this application and know the same/too beYtruecand� correct.ecAll:.visions of laws and ordinanceslgoverning this <br /> type of work 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 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 application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 0% s/8/ae <br /> E OL-M <br /> 0/ eriAuthorized Agen ignature Date (Revised 9019212095) <br />