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� �n ��r�ec�� ����i� �°���ic���on� <br />CITY OF EVERETT PERMIT S�kvICES <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 INFORM/�,TIOIl1 <br />PROJECTADDRESS: �','� �l <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATfACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: r' ; �- <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 />DESCRIPTION OF WORK: �. � _ � <br />.,, <br />CONTACT INFORMATION <br />OWNER NAME: �� � `� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReET <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: �, �'�� , ,ti-� i�;� — �� � �_� ,_ _�� <br />, _ l_ <br />CONTRACTOR ADDRESS: sTReer ;'�Z _S � (,� � " � - � �� ,'i �L r '� " i� <br />CITY / � � �1 STATE �./J�---�� ZIP � �' � `' y`-- <br />; ,� �_ �, . � V _ _ / . <br />CONTRACTOR PHONE:� �r.\: ,.- �'�. L� �, CONTRACTOR EMAIL: �� --,_;,, "_ � 1 �� .�� , f , <br />F. <br />CONTRACTOR LIC. #(REQUIRED): �' � � ? E`��' f , u�.�_ �'��C `�% ' CITY OF EVERETT BUSWESS LIC. #{REQUIRED) > `�� - <br />PRIMARY CONTACT: �.OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT. T hereby certify fhat l have read and examined ihis 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 herern or not. The granfing of a perrnrf does not presume to give authoriiy to violate or cancel the provisions of any ofher state or <br />local law regulafing consfruction or the performance of construction. That I am authorized by the owner of this property to perform fhe work for which application is made and I <br />comply with the State Confractors Law 18.27 RCW and 296.200 WAC. <br />� <br />rized Agenf <br />�' 1�� _ - <br />%" � i. � , ; � � <br />. � <br />, <br />�� /�; j`- _ .. <br />City of Everett Official Use Only <br />FEE <br />� f� C; L� <br />PERMIT # <br />E (����_��cy <br />(Revised 90/17J2095) <br />