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�I�CC��'�A���. G'C�f+�B�01( ,l�'�f����`�Q�� <br />CITY OF EVERETT PERMIT S*RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 j(E) everetteps@everettwa.gov f www.everettwa.gov/permits <br />PRO��C`➢' S17'� 9G��'��Y!!iA`('IOPd , <br />_. <br />, ; <br />_ <br />PROJECT ADDRESS: �� v � I �� -�'�( <br />� <br />BUILDING AREA (if residential, new construction, remodel, or addition) k-Pi �� � SF <br />SUILDING TYPE: �SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �`, j t� �, <br />ELECiR1�AL �PPLICA'T'Q�PB 9f�9F�7RIY��7'lOQ�I <br />CONTRACT PRICE OF WORK: $ L( UU `�'J <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicabie): <br />DESCRIPTION OF WORK: `� r' r , ; r, � `'� �• �� 1 � � n <br />-, — � � ' <br />�. .� <br />: , _ CONTACT INFORMATION _ , <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREEr <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />.. .. ._.:_ . _... .,,. _ _..__ ___ . ,.. ...,_. _ -:..__�. ,..,.:.. . _. _...._...._. _ - - - - - - <br />�.. .. . ..._.._.._.-_ . _ . ....._... ...... �._...._ . ... <br />CONTRACT�R NAME: �-j�^ � j c- ; n r �� <br />CONTRACTOR ADDRESS: sTReET (� � � <br />^ � 7 <br />CITY l,/• W STATE � ZIP <br />CONTRACTOR PHONE: '�� �- j U - (, . j' CONTRACTOR EMAIL: - � � �M.<<� ' "� h, � <br />CONTRACTOR LIC. #(REQUIRED): ��� � � V � I`1 CITY OF EVERETT BUSINESS LIC. #{REQUIRED)✓` � ` �' ( � <br />PRIMARY CONTACT: ❑ OWNER I,�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE; � �" ( r� <br />C� � �'v �C� ' � � <br />�� C,�, � CONTACT EMAIL: � � ��.,, .�, <br />Ac�KttMtN l: � nereby cemty tnat r nave reaa ana examrnea rnrs appucarron ana rcnow rne same ro oe rrue ano correcr. Hu p�ovrsions or iaws ano oroinances yovermny uus <br />type of work wi0 be completed whether specifred herein or not. The granting of a permit does not presume to give authorify to violate or cancel the provisions of any other state or <br />local lav✓ regulating consiruction or the perFo�mance of consfruction. That I am aufho�ized by the owner of this property to perform the work for which application is made and l <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />` �G�, /c�%i <br />Owner/Authorized Agent Signat re Date <br />City of Everett Official Use Only <br />r-EE <br />� C%( ' �! �, <br />PERMIT # <br />��l (�� � � �� __ � �; .�, <br />(Revised i0/12/2015) <br />