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�����.I�/�� ����A� ��I�I�/��f�� <br />CITY OF EVERETT PERMIT SEr�JICES <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 />P9tOJECi SITE INFORNiAT10Pl <br />PROJECT ADDRESS: `'� �- � � � � �v1 C% � j/i ►� � <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: ``� i L�,..,.+� � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES �1 NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: <br />.l i1 > ' �, -'�' � (� ` •-� 6 � `t,� <br />CONTACT INFORMATION <br />OWNER NAME: �b�-�� ��i�'�i� a' ! �� � � TENANT NAME (If Commercial): (� i � <�'� + <br />OWNER MAILING ADDRESS: sTREEr <br />CITY STA7E ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: ,N i.� �ti� �= <br />CONTRACTOR ADDRESS: srReeT <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSWESS LIC. #(REQUIRED): <br />PRIMARYCONTACT:.__..I�iOWNER ,,.,.0 CON . : .:...... . ......_.. , . _.._._. _ .-,,.,._..... _._... _.. .....,,..., .._-.._._.. .... <br />TRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE; L L � �l C: ��, �� <br /><C���C�CI � 'I�vLE � /� CONTACTEMAIL: /Y>� _��'djl'� S � Ljl '���, r LIJ�rY1 <br />AGREEMENT.� T herebvi certifv fhat I have read and examined this applicafion and know ihe same to be t�ue and correct. All p�ovisrons or laws an ordinances goveming thrs <br />type of work will be completed whethe� specified he�ein or not. The grantrng of a permit does not presume to give aufhority to violate or cancel the provisions of any other state or <br />/ocal law regulating construction or the performance of construction. That I am authorized by the owner of fhis property fo perform the work for which app/ication is made and l <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />orized Agent Sfgnature <br />�� ��� �� <br />Date <br />City of Everetf Official Use Only <br />FEE <br />� �� c�i�-� <br />PERMIT # <br />� ���- ��� <br />(Revised 10/12/2095) <br />