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��cT�ic�� ���nni� ��ic��rioN <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 INFORMATION <br />PROJECT ADDRESS: � `� �/' (� � � �b,;j <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: COMPJIERCl/aL <br />USE OF BUILDING: ���; ",� Q/- %f L L,� S� <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: j,.�i�Cc�rin��� ��;; , • r•r,��� � ,,,ta�, � � �. <br />� G�'l i'� � (,e C c•� • <br />OWNER NAME: �'� �Q YYl Yj7 � r� � <br />OWNER MAILING ADDRESS: srRee-r %/ � <br />cirY JC�VC� P 1�' <br />OWNER PHONE: � 2� --% yrl � Z3 �f � <br />CONTRACTOR NAME: �G{ � %�i�j; rj �,��,�1^�� <br />CONTRACTOR ADDRESS: sTREer �/(�(J �/ <br />i <br />cirv %L V C/1 r� <br />CONTACT INFORMATION <br />�,T"�� h j,� TENANT NAME (If Commercial): S �i y}7 <br />o l�� rvlN t �•�., �,�� <br />OWNER EMAIL: <br />STATE 1/ ✓y�'� ZIP ��� � <br />r�' y�w <br />STATE <br />,p' <br />ZIP d" <br />CONTRACTOR PHONE: Z,� - yV� '' i�� L CONTRACTOR EMAIL: �� � ., j/� /'C' • C+ <br />CONTRACTOR LIC. #(REQUIRED): '�/ ' � _� -` ' N CITY OF EVERETT BUSINESS LIC. #(REQUI ): (�Z��� <br />. _ . _. _ _ _ _ _ _. _. _: _. <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) ��---- <br />CONTACT NAME: CONTACT PHONE: ZS+� -? Z�_ � �� <br />S� . ��C) CONTACT EMAIL: �� • � �.� ,. f <br />AGREEMENT.� T hereby certify fhat i have read and examined fhis application and know the same to be true and correct. All provisions of /aws and ordinances governing this <br />fype of work will be completed whefher specified he�ein or not. The granting of a pe�mit does not presume to grve authonty to violafe or cance/ the provisions of any ofhe� state or <br />loca! law �egulating construcfion or the performance of construction. 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 State Contractors Law 18.27 RCW and 296.200 WAC. <br />d Agent Siynature <br />City of Everetf Official Use Only <br />FEE <br />�2-� 2 � 5 � <br />PERMIT # <br />E 1�0� -��� <br />(Revised 10/92/2015) <br />