Laserfiche WebLink
�� �� <br />I�►� �, _ ..- - <br />i_ - <br />� � <br />������'��� ������ ����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@everetiwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMA'i101d <br />PROJECT ADDRESS: % , j � LC �Y '„vtj � � <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: — <br />ELECTRICAL APPLICATIOM INFORMAiIAN <br />CONTRACT PRICE OF WORK: $' �lig •�� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: "� j, " � J,�"�,�� � <br />�' � <br />CONTACT INFORMATION <br />OWNER NAME: hf �' '� �( � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer �.� Z ��' �,. <br />CIIY � - STATE ��� ZIP �/ .�( �i <br />OWNER PHONE: �-�, 1 � OWNER EMAIL: <br />. <br />CONTRACTOR NAME: J��✓!.-(� ,� . ' ,ly <br />CONTRACTOR ADDRESS: sTREEr ��' L� f � <br />CITY ��� �.� STATE � 'ry- ZIP / <br />CONTRACTOR PHONE: � 1 ��� 2 CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REqUIRED): ���/�,f�^ f�'�'.,�,� :1� CITY OF EVERETT BUSINESS LIC. #(REQUIRED):�/ G,' ���' <br />. ___, , _ ... .. . _..:. ___....:. . <br />_.._. . . ._. . .... : , . . . ._:. ....: . . , . .. <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ��THER (Please Specify) ( �� �f_J�%( / QJ,� �' �'�`�/�../ <br />CONTACT NAME: �j �� `,� CONTACT PHONE: �� � � � � � <br />�G��/�.� fC_I �,►,�� ��`. CONTACT EMAIL: <br />AGREEMENT.� T hereby certify that 1 have read and examined thrs applicafion and know the same to be frue and correct. All provisions of /aws and ordinances governing this <br />type of wo�k wrll be completed whether specified herein or not. The graniing of a permit does not presume to give authoriiy to violate or cancel the provisrons of any other state or <br />local law regulating construction or fhe performance of consfruction. That I am authorized by the owner of fhis property fo perform the work for which application is made and I <br />comply with the Sfate Confractors Law 18.27 RCW and 296.200 WAC. <br />orized Agent Signature <br />Crty of Everett Official Use Only <br />FEE <br />�,��� �lD�oo <br />PERMIT # <br />E l 1���- e <br />(Revised 90/92/2015) <br />