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� _. <br />..►�' <br />v���(� <br />���r�ic,�L ����o����ic���o� <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 />PROJECT SITE IWFORIii1AT101d <br />PROJECT ADDRESS: �� �� ,n } v�,��� J I� <br />BUILDING AREA i resid�r,�js"�l�new construction, remodel, or addition) SF <br />BUILDING TYPE: SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: y--� �� �\ <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ � ' <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES l�d'NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): ,ti1 <br />DESCRIPTION OF WORK: - � — <br />a_ ` <br />CONTACT INFORMATION <br />OWNER NAME: ��"Z TENANT NAME Qf Commercial): <br />OWNER MAILiNG ADDRESS: sTREET � ��Z� cN' � 1��' �i <br />CITY �L`Q,1i �'(T STATE �J� ZIP �(�LL% � <br />OWNER PHONE: �l�"�% ��� l`(��UO OWNER EMAIL: K y-� � v�nt�,i�� - C-Uw� <br />_.. ._ _ _ .. _. ._ ._. .... <br />_ _ ,. - _.._ __ .,. .. . . ., _ ... . ._.. . _,... . , _. <br />_ . _ . _ ... ... . . . �. ... ... __., .. . _.. , ..._. ._ . <br />CONTRACTOR NAME: � ��,.� � ��� � <br />CONTRACTOR ADDRESS: sTREET � z u l, q�� �tix. �� <br />CITY ((}t'�_ �7�j�.�/� STATE W � ZIP `�S� <br />CONTRACTOR PHONE; f Z� `ZL��- -�S� � CONTRACTOR EMAIL: (/��,� w���Cl�-�'� C_ , Cpv� <br />CONTRACTOR LIC. #(REC2uIRED): �j �T�G�EL�I LCJ�� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �Ej � <br />PRIMARY CONTACT: ❑ OWNER I�ONTRA <br />CTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �' ��v- K,��Z�� CONTACT PHONE: �"ZS'Z�{� -�j�l � <br />CONTACT EMAIL: �'` ..����l��y-�� � �yv� <br />AGREEMEN I' 1 hereby certify that I have reatl and examinetl this appucat�on and Know tne same to be true and correct. Hu provrsrons or laws ana orarnances govemrng rnis <br />type of work will be completed whether specified herein or not. The granting of a permif does not presume to give authorify fo violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construcfion. That I am authorized by the owner of this property to perform the work for which application is made and I <br />comply with the Stafe Confracto�s Law 18.27 RCW and 296.200 WAC. <br />r/Autfiorized Agent Signature Date <br />Cify of Everetf Official Use Only <br />FEE � <br />� ��'r�, � <br />PERMIT# <br />� I ��l � �v � <br />(Revised 90/12/2015) <br />