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� <br />� <br />�i�����.ic�� ���nni� .���ic��io� <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: ��� L .� � lb''�'`" lr.`..=1� �f� <br />BUILDING AREA (if residential, new construction, remodel, or addition) ��� � �� � l SF <br />BUILDING TYPE: ❑ 5FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX [� MULTI-FAMILY -# OF UNITS:�Z ❑ COMMERCIAL <br />USE OF BUILDING: /�l�l,+-I ) i �Z:�V�LL��� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ (I �" `' , . �C'<�� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: �G`�4��• ��: ,�,L. i� .��;:�0 1� L� E�4`i�� <br />CONTACT INFORMATION <br />OWNER NAME: �L'k�. � e �.5 �.^� TENANT NAME (If Commercial): <br />� <br />OWNER MAILING ADDRESS: srReeT ,7 � � �� -S 7 ��i'V'`'- •ti � <br />CIiY � ��'y- �/ �' STATE �(J. ZIP �1 Q � � , j <br />� <br />OWNER PHONE: � OWNER EMAIL: N.� <br />CONTRACTOR NAME: 1 l�' i ��` -�c:�` <<' <br />CONTRACTOR ADDRESS: sTReer .2. Z 3� � ��-S . <br />CI'iY C�� E� ' STATE �V� / 1 ZIP �� �-� �� <br />CONTRACTOR PHONE: 'uSZ. 5�.z YC 7Z� -�C- CONTRACTOR EMAIL: �C4 �`�C � F'� �C�� '�-' ��-_ �_�,�� <br />CONTRACTOR LIC. #(REQUIRED): ���� ��'� � �� Z � 7 CITY OF EVERETT BUSWESS LIC. #(REQUIRED): � <br />PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �, CONTACT PHONE: �` � i�c� �' - f�'� � � ' <br />i ; �1 �-1��I �- <br />CONTACT EMAIL: <br />AGREEMENT. T hereby certify that l have read and examined fhis application and know the same to be true and correct Ali provisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or not The granting of a permit does not presume to give aufhority to violafe or cance! the provisions of any ofher stafe or <br />local law regulating consfruction or the performance of construction. That l am authorized by the owner of this property to pertorm the work for which application is made and I <br />comply wiih the State Confractors Law 98.27 RCW and 296.200 WqC. <br />, <br />`7,,....-� ��_�= ( � - � Z t C: <br />Owner/Authorized Agent Signafure Date <br />City of Everett Official Use Only <br />FEE � <br />�1 I � <br />l ��� <br />PERMIT # <br />E <br />(Revised 10/12/2015) <br />