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��!"�- . <br />�� _ <br />• • <br />�LE�iRI�A� ��RMI°� APP�I�A,�'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 />PROJECY SITE INFORMAiION <br />PROJECT ADDRESS: ( , � � ' {� <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: r`�'�. � ,/✓��, � � � �• � � � � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �, GQ <br />NUMBER OF DEVICI=S (if low voltage): <br />FIRE ALARM? ❑ YES � NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: ��- '^� j/t p � LO <br />CONTACT INFORMATION <br />OWNER NAME: ' � � �M TENANT NAME (If Commercial): � �� � �'. �/�/1 � <br />OWNER MAILING ADDI�ESS: sTReer �,`} � v�� <br />n_ /� <br />CITY 1'� STATE � � �. ZIP �lJ <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: M(� � ` +(�1 <br />CONTRACTOR ADDRE,3S: sTREET �p � ,�� � <br />crrv S'�1 O l CJ<^�1 ') S' STATE �./4- ziP ��� <br />CONTRACTOR PHONE:, ,� �O - � �'. - .'�j` 3CO CONTRACTOR EMAIL: Q � � �� MCti�JtZ U � ".� i ' . " ). <br />CONTRACTOR LIC. #(REQUIRED): �S- ^C '7 •• CITY OF EVERETT BUSINESS LIC. #(REQUIRED): Q -� �(� <br />_.. _ , __ _ <br />PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 3�0 _�� �.— � 3Cj� <br />K. r ,^ CONTACT EMAIL: <br />� <br />AGREEMENT.� T hereby certiy that l have read and examined fhis application and know the same to be true and correci. Al! provisions of /aws and ordinances governing this <br />type of work will be completeo whether specified herein or not. The granting of a permif does not presume to give authority to violate or cancel the provisions of any other state or <br />local !aw regulating construction or the performance of construction. Tl�at l am aufhorized by the owner of this property to perform the work for which application is made and i <br />comply with the State Contractois Law 18.27 RCW and 296.200 W,4C. <br />o2G <br />Agent Signature Date <br />City of Everett Official Use Only <br />FEE <br />� o �b <br />�. <br />PERMIT # <br />� I l - I �Z <br />(Revised 10/12/2015) <br />