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<br /> h _C CTRiICAL P RMIIT r;.� PLIC.A`1 I ON
<br /> i � CITY OF EVERETT PERMIT SERVICES.
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> fl3?t;$tiAliet M t Q IF C,A`>1©GNd �', . . .'. •. -
<br /> !PROJECT ADDRESS: il'i '*
<br /> 1 BUILDING AREA(if residential,new construction,remodel, or addition) SF -
<br /> BUILDING TYPE. FR-DETACHED ❑SFR ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
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<br /> USE OF BUILDING:
<br /> !EL C ':'II:C;, 1�;APPLOCasATIION JINN i':it�i TWN
<br /> CONTRACT PRICE OF WORK:$ /era-e) '
<br /> NUMBER OF DEVICES(if low voltage):,
<br /> FIRE ALARM? ❑YES 10
<br /> ASSOCIATED BUILDING PERMIT#(if applicable);
<br /> DESCRIPTION OF WORK: t",, .5 /r f
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<br /> OWNER NAME: 61 ti✓.^yy Da,..l��..y4114 4,1 TENANT NAME(If Commercial):V
<br /> OWNER MAILING ADDRESS: STREET / j Prue, s 1
<br /> CITY 61/'e40- ,' STATE 1..A.--,4 ,p5ezc /
<br /> OWNER PHONE: OWNER EMAiL: /
<br /> CONTRACTOR NAME: 4. ys : G 4.,,," 2,--. ..
<br /> , ---1- -,74 J ,
<br /> CONTRACTOR ADDRESS: STREET p7 Z.C7 /L� -,/, cS A4I 0CITY /•+.(W)/-E;ptij STATE t•A"..:4 ZIP 9r -_,7
<br /> CONTRACTOR PHONE:20797 79 Z 6 CONTRACTOR EMAIL: /34.4.E..4.----- %L C v 6/4,41,....T`. L.,
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<br /> CONTRACTOR LIC.#(REQUIRED): AZ.t-��' y6 07,� CITY OF EVERETT BUSINESS LiC.#(REQUIRED):—11110
<br /> PRIMARY CONTACT: ❑OWNER --at ONTRACTOR Cl OTHER(Please Specify) g 0"1 049 /A9L
<br /> {CONTACT NAME: /� CONTACT PHONE: Z0 6, 7 53 77'16
<br /> , A,.....1, j�e_ !� 0,G Y-/S e,.� CONTACT EMAIL: pl.�.wC:G, C2, 41/ P.._ r,.i r`t,_- Y G
<br /> AGREEMENT:T hereby certify that I 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 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 l 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 /> , ,. 7_ / ? E ill\i/0 -3
<br /> •wner/•, horized Agent Signature Date (Revised 10/1 5)
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