Laserfiche WebLink
���������� ���.�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@ev�rettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE IIo1FORi11fAT'IOid <br />PROJECT ADDRESS: '� � j, C �>>� p��" l�i� V�� <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: E7 �C�� � � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $� Z�t� � i,�''J <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: �� r'j��c �l, -�,.f�..L> '[�.-C�t� i� �ti ';l� <br />� Q.. ,�' i�'l�,e � I.�U �, li� ... <br />CONTACT INFORMATION <br />OWNER NAME: ��-'+`�l j� �'�l�fE �'"p��"� TENANT NAME (ff Commercial): <br />OWNER MAILiNG ADDRESS: sTREET �i ��L-� <br />CIN �'�� ! STATE V�/Ct. ZIP � l <br />OWNER PHONE: �'ICLYi' ��J � � OWNER EMAIL: <br />_ . _... . __. _. .. .... _ _._ . <br />_ _.__-_ _ . __._.. ___ _ _ <br />_ _ __. .� . _ .... _ ., .. , _. ._ . <br />CONTRACTOR NAME: �i1ti �`-�%����. C;� �%C Ct '7' (i '� CC � <br />CONTRACTOR ADDRESS: sTReeT ��r � r:c ' �-�I1� <br />CITY �Yh.i1r''� STATE �� ZIP �% � <br />CONTRACTOR PHONE: ��C1 �-�Z I 7�,• CONTRACTOR EMAIL: � Y{CL"v'�,.� 1Z(� � LE'r �' ��� �' Y.%-� <br />CONTRACTOR LIC. #(REQUIRED): ��j C� � `qZ CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �,� j � <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� � ��G� <br />��i�►!�� � ��1�vLZws CONTACTEMAIL: <br />AGREEMENT.� T here6y certify that 1 have �ead and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this <br />type of work will be completed whether specified herein or not. The granting of a permif does not presume to give authority to violate or cancel fhe provisions of any other state or <br />/ocal law regulating consf�uction or the performance of caistruction. That I am authorized by the owner of this property to perform the work for which application is made and ! <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�y � <br />��/l.�}� �,r�v � � i7. � L (, ,�j✓�-% <br />� `��' <br />Owner/Atrthorized Agent Si <br />Date <br />City of Everett Otficial Use Only <br />FEE <br />� � �� � <br />PERMIT # <br />� I � �� � I ��'. <br />(Revised 90/12/2095) <br />