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�����i���/�� ������ /������/��I�N <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 />PROJECTADDRESS: d��O� �� �� /,—l/ � ��V�,,- (' � TT �,.ZU_� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF c� t%/� <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: COMMERCIAL <br />USE OF BUILDING <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ L�S�G� !� �' `� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES [�.�NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTIONOFWORK: �t/'�'� �ri//a-�+-� .5��� �/L ��G��S�� -'U`r�i'i'.�i� �T <br />c�,�i,�� � ��; � �.�J .ti�� ���-.--, s.� IL 7��� � <br />� �i'r�� ,`� <br />,, <br />� r ���v �'�J �fi re %��� tTS��- <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): 1� � V � � T� c�, K <br />OWNER MAILING ADDRESS: srReFr <br />CfTY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: C'�- S C�' �i{ =c� � � r � ✓ �v� ,� /�� T� �' �. - <br />CONTRACTOR ADDRESS: sTREET QC�� = �`,.�� � (� S <br />CITY ��'��� STATE �� ZIP ^ <br />CONTRACTORPHONE: �(�CG� ��G'G> S�'-�5� CONTRACTOREMAIL:�J�.��I<�y- CCCf��.��C —/`-��C.G;�Ivlt�r ��UM <br />CONTRACTOR LlC, #(REQUIRED):�'� ��-,C U� �- CITY OF EVERETT BUSINESS LIC. #(REQUIRED):C��l` `.�� <br />..._. _..,._. ,.. :. _ .: ............ .. ..._.. .. . . ........_ _.... ._ .., .... : _. . ....__ _.._:. _...._ <br />PRIMARY CONTACT: ❑ OWNER ��CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� C C/G> L S'��5,7 <br />� <br />J c-i/'V y� V��C���-�� CONTACTEMAIL: ��J,\C�CC�'' ' c,- �c1Ccl,�f— Gc.L.�v�t� r v <br />H(�KttIVItN 1: I nereoy cerr�ry rnar � nave reaa ano exam�neo rnis appucar�on ana xnow rne same ro .oe r�ue ano correcr. Hu prowsions or iaws ano oro�nances goveming rnis <br />type of work wil! be complefed whefher specified he�ein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any otherstate or <br />locallaw regulating construction or the performance of construction. That l am authorized by the owner of this property to pertorm the wo�k for which application is made and I <br />comply with fhe Stafe Confracfors Law 98.27 RCW and 296.200 WqC. <br />�- %��� s'-�� <br />Owner/Authorized Agent Signature Date <br />City of Everetf Official Use Only <br />FEE <br />Y\ '�� 1�� <br />PERMIT # <br />E�(�LI' �o <br />(Revised 10/12/2015) <br />