Laserfiche WebLink
���iRIC�4L PERIIniT ��'LICATIOtV <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 IfdFORMAYl0�1 <br />PROJECT ADDRESS: �,� I�O� � ��--L��- <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: �� 1 nl "T I ra� OS � V�I �+�..�� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ � . <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES O <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: �c�. � � �=TO <br />�. a�o1 f� �' � L C� /�% � � 1 '� � <br />CONTACT INFORMATION <br />OWNER NAME: ��]CA� Vc" P�� N� � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT Q� � �%' � L..�,� <br />CITY �v� �� �J STATE � � ZIP � <br />OWNER PHONE: � 2��' �SZ —�2' �� OWNER EMAIL: <br />CONTRACTOR NAME: B�Q�SS 1 � � �� �. �Z1 �fi�. �� <br />CONTRACTOR ADDRESS: srReeT G _ �� �% � <br />CITY � �� 1� �� STATE ZIP� CI✓� <br />CONTRACTOR PHONE: ZS' ^,3 ��' CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): ��A �� �� �� CITY OF EVERETT BU5INESS LIC. #(REQUIRED): D�� <br />_ ...... ...- �.� . _.�...... . :. _.. _..-:.....: .... _ .._.._..., ..... <br />e:.. <br />_.. .:.._._ ,.._ .. . _. .:..... ...... .: . . .... ..... .... <br />PRIMARY CONTACT. ❑ OWNER �ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��� .— `����+ � <br />��(.,� 0 (s. ��j��� � /� CONTACT EMAIL: <br />AGREEMENT: T hereby certify fhaf 1 have read and examined this applicafion and know the same to be true and correct All provisions of /aws and ordinances goveming this <br />type of work will 6e completed whether specified herein or not. The g�anting of a permif does not presume to give authonfy to violate or cancel the provisions of any othe� stafe or <br />local law regulating consfruction orthe performance of construction. That l am autho�ized by the owner of this property to perform fhe work for which applicatron is made and I <br />comply with the Stafe Confractors Law 18.27 RCW and 296.200 WAC. <br />�' _ � <br />_ ;� � � <br />Owner/Authorized Agent Signature <br />City of Everett Official Use On/y <br />FEE <br />102 ,�� <br />PERMIT # <br />�ll�U�-bZ�1 <br />(Revised 10/12/2095) <br />