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�����I��� ������ ���I������ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />P�iOJECT SIiE IPIFORMATION <br />PROJECT ADDRESS: Gj� D Z IG <br />BUILDING AREA (if residential, new consfruction, remodel, or addition) SF <br />BUILDING TYPE: �j SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: <br />ELECTRICAL APPLICAYION INFORMATION <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � S <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREET <br />CI7Y STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: srReer <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): D�' I�. � CITY OF EVERETT BUSINESS LIC. #(REQUIRED): U' 1 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT.� T here6y certify fhat I have read and examined thrs application and know the same to be true and correct. A/l provisions of laws and ordinances governing this <br />type of work will be complefed whether specified herein or not. The granting of a permit does nof presume to give authorily to violate or cancel the provisions of any other state or <br />/oca/ law �egulatrng const�ucfion or the performance of consfruction. That l am authorized by the owner of this prope�ty to perform the work for which applicafion is made and ! <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Owner/Authoriz�d Agent Signature Date <br />Cify of Everetf Official Use On/y <br />FEE <br />���t�� <br />� <br />PERMIT # <br />E�(�nz-1�� <br />(Revised 10/12/2015) <br />