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!LECTRCAL 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 9 29 • <br /> ,jYT j fJ/zT <br /> BUILDING AREA(if residential,new construction, remodel,or addition) / 3 O SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: 'jam <br /> CAL APP ICATION INFORMATION . <br /> CONTRACT PRICE OF WO :$ O� <br /> NUMBER OF DEVICES(if to Ita e : <br /> FIRE ALARM? 0 YES MK) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2sx/? <br /> 2e,"7"7 U062_, <br /> CONTACT INFORMATION :; - <br /> OWNER NAME:,, 0,4-// / C,'L��/S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,�'2 f / '7 <br /> Gay L L r STATE �je ZIP /P 2 / <br /> OWNER PHONE: {2 S� -2/D—6(K`$" OWNER EMAIL: Rge..( 1✓r/Lt/fL/cv c� L L. <br /> CONTRACTOR NAME: l _. N cd? <br /> CONTRACTOR ADDRESS: srREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 lam 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 /> c - 0 3 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />