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�ECTRC L PERMIT AP�CATIDN <br /> I A <br /> GITY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-88�7 � (E)evere#teps t�t everettwa.gav� www.everettvva.�ovlperrnits <br /> _ _ _ .. <br /> �i PItiDJECT S�TE IN�4RMATl�l�l,. `� <br /> PRWECTADDRESS: 1��� � t � - <br /> BUiLDING AREA(if residential,new construction,remodel,or addition) SP <br /> BUI�DING TYPE: ❑SFR-DETACMED ❑SFR-ATTACHED ❑DUPLEX ❑MUL'FI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: -�l <br /> ELECTRIGAL°�►PPL'1�qTl�N MNiFORMATION :. . <br /> CONTRACT PRIGE OF WORKt$ , (� <br /> NUMBER OF DEVICES if low volta e : � <br /> FIRE ALARM? ❑YES -�'NO <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> DESCRIPTION OF WORK: � 9 �r� t <br /> L� � � <br /> �C4N�'ACT INPORMATIQN �" ; - <br /> OVYNER NAME: � TENANT NAME If Commerctai: 'b <br /> OYYNER MIUI.ING ADDRESS: s�er C") • � <br /> V'r ZIP �� /.i_/�I� <br /> �y ` l STATE � X <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOl7 NAME: � -P •� "�' <br /> CONTRACTOR ADDRESS: s�er �• <br /> GTY STATE 7\ 21P <br /> CONTRACTOR PHONE: •' —(, CONTRACTCR EMAIL: S� <br /> CONTRACTOR LIC.#i(REQUIRED): S l L CITY OF EYERETT BUSINESS LIC.!�(REQUIRED): �$ <br /> __ __._.__ .�_.,__. __,_.. <br /> - _ _ __. __ . _ .. <br /> PRIMARY CONTACT. ❑OWNER .�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTAGT NAME: CONTACT PHONE: 3(,�I(�.- �L(� I�j�� <br /> �I V� �/l.(�I U��S� CONTACT EMAIL: �-- .�, 2'+r'�• <br /> AGREEMENT_!hereby certify that 1 ha+�read amd exarr�u�d this apM+�atu�n and larow the samd to be hve and oorrecL Aq pravi*rons of laws and adri►arrc�s goveming this type <br /> Of worfcwill be oompleted whetherSpeGrfied herein or nat. fie gr<rnting of a pemvt does notpresume to give auttwrity ta violate orcancet the provis+ons of any other state or <br /> focal law regu/aling ooRsb+rcfiort or Ure perfomyance of construd�. That f am authorized by iAe own�r of this propeRy to perfam the warkfor whbch app(r�tfon is made and! <br /> oomply wiM the State Cortbattors Law J827 RCW and 296.200 WAC. <br /> City of Everett Otfrae!Use OMy <br /> — PERMIT# <br /> ` � �� � 1 I <br /> OwnerlAuthorised A�ent r�ure Dat (Reviseci 9/2�2D16) <br />