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• � � ��=��r�ic,�� ���nni� ����ic��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@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE IRIFARiV1ATlOi�1 <br />� <br />PROJECTADDRESS: , ��,��� � � � ��_i-=-,�-p p'��:�t,�;-- <br />BUILDING AREA (if residential, new construction, remodel, or addition) S <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: ' <br />- � <br />._-�� ; : <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ _ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />__ <br />DESCRIPTION OF WORK: � ��=- �-r- ;� � `�� -`,� � �.-�"- � ;� G� <br />CONTACT INFORMATION <br />OWNER NAME: rl i � �-='—r _ TENANT NAME (ff Commercial): <br />OWNER MAILING ADDRESS: sTReET <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: "`` �> , :� I ' � - �-- z' ;- <br />>- ,:, <br />CONTRACTOR ADDRESS: sTReeT <i� -� j _� ' "�`� � f �'�— • ' <br />CITY ���y ,. �' G.�-�1\` STATE ; ,. � �' _ ZIP '-1 ,:�,L� .�!f;. <br />� ^� - -- ' - � ` , <br />CONTRACTOR PHONE: _ - �i `` -�7C'Z CONTRACTOR EMAIL: - - �� c , � � ' - -d i , _ _.�� <br />CONTRACTOR LIC, #(REQUIRED): ,� � � _� '„ , / ` �' CITY OF EVERETT BUSINESS LIC. #(REQUIRED) � �� '�`,` <br />PRIMARY CONTACT: 'I�OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />C�NTACT NAME: CONTAC7 PHONE; <br />CONTACT EMAIL: <br />AGREEMENT.� T hereby cerfify that I have read and examined this application and know the same to be true and correct. AI! provisions of laws and ordinances govemrng this <br />type of work will be complefed whether specified he�ein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any other state or <br />local law regulating consiruction or fhe performance of construction. That l am authorized by fhe owner of this property to perform the work for which application is made and I <br />comply with the State Confracfors Law 18.27 RCW and 296.200 W,4C. <br />��� � � � j / _. __ <br />_ _ '/r - .,1 � <br />- -i � - -� �' - - <br />Owner/Authorized Agent Signature Date <br />Cify of Everett O�cial Use Only <br />FEE <br />� -� ���D <br />PERMIT # <br />� I�U�-vl'7 <br />(Revised 10/12/2095) <br />