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� ���c��ic�� ���n�i��Lic���o� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET; EVERETT, VUA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 j (E) everetieps@everettwa.gov ! wvyv✓.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PR�JECT ADDRESS: I�j' Z.� C (� A V r <br /> BU�LDING AREA(ii residential, new ccnstruciion, remodel, or addiiion) SF <br /> BUILDING TYPE: ❑ SFR-DETACFiED ❑5FR-Al-f"ACHED ❑ DUPLEX ❑ hAULTI-FAMILY-�OF UNITS: ❑COMMERCIAL <br /> USE OF BUfLDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CON7RACT PRICE OF WORK: $ I�UO.� <br /> NUMBER OF DEV(CES {if low volta e): <br /> FlRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 'T,n }�,,�� � (�F�� �-. � (,�� J� �3� �-1- L�_ f <br /> C.�...� Ct r'�t,.��k, ,n <br /> CONTACT (NFORMATION <br /> OWNER NAME: T f��;�c.`k_2_.���,. �,�.,y��t w.� TENANT NAME(If Commercia!}: <br /> OWNER MAiLiNG ADDRESS: s-aeEr <br /> crrv <br /> S7ATE Lp <br /> OWNER PHONE: OWNER EMAIL: <br /> _. <br /> _.. <br /> _ <br /> CONTRACTOR NAME: V tC'r� �(�tv ti(,r <br /> CONTRACTOR AODRESS: srnE�r `�(;} - .,U�„tL �. <br /> CITY •�„rz.'�� STATE ��"i ZiP �Gl���.� <br /> CONTRACTOR PHONE: 'L�,(;, -r-f'�,� :�7.+C(�� CONTRACTOR EMAIL: <br /> CONTRAC70R LlC.#{REQUIRED) � �C.+�G�,,:���Z�1�,'�„ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C�7c'�y�'"j�f S� <br /> _,..._... .. _.. _....... _,. <br /> __. _ _ <br /> - ._ ..._._., .:.�.... _..... ..._.- �:_ <br /> PRIMARY CON7ACT: ❑OWNER �� " � <br /> . ... .... ......... __..,._.:.,.-._..- <br /> CONTRACTOR ❑OTHER(P(ease Specify) <br /> CONTACT NAME: CONTACT PNONE: Z�';�_ • <br /> '�`� €=s`��"�-t� �. <br /> ���'�+ ��1�Yli.�.'C� CONTACTEMAIL: <br /> ���hf< J�Gi�Cr��Uw�:.�� �. �f�.�FF.CC.�S'9. <br /> AGREEPl,ENT.�T i•,e;eby certrfij thaf!have;�2d ard ex.amrr,ed inr's application and kr,o�;r fhe same fo b=t�ua and correct A!/prov,sicns of/aws and ordinances goveming fhis <br /> type o;tvo�k v,�i;l be compleied v✓nether specified herein or not. The granf;hg of a pe:mit dces ne:presume to give authority to vlolate or cancel the provisions c;any other sta'e or <br /> local la:v�egurating construcficn or fhe performance of construciion. That l zm aufhorized by the o�frner oi this property fo pedorm the uiork;or which zp,olication is made and! <br /> ccmp,y tvith the S!ete Confractors Law 98.27 RGW and 296.200 WAC. <br /> C;ry of Evereit Of,";ciai�'se Only <br /> FEE <br /> � -�2-.`�°-� <br /> / PERMIT# <br /> ' ���02-d(� <br /> zs ��- <br /> 0 er/Authorized entSignature Dat <br /> (Rev.+sed 10/12/2015) <br />