Laserfiche WebLink
�.E�TRIGAIs PEF2MIT A�LICATIAN <br /> CITY OF EVERETl PERMIT SERVICES C���z '"b�Z <br /> 3700 C[DAR STREET, [VERETT, WA 98201 /Z�-!b "�S <br /> (P) 425-257-Ba10 � PAX 425-257-8857 � (E) everetteps@everelriva.gov � www.evereltwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,�j I V S f Jl� I.V� " w <br /> BUILDING AREA(if residential,new construction,remo el,or additian) S� <br /> BUILDING TYPE: Q1 SFR-DE7ACHED ❑ SFR�ATTACHED ❑ DUPLEX ❑ MULTI-.=l1MILY-#OF UNITS: COMIdERCIAL <br /> US[OF BUILDING: � �"( U —� ✓�vt <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: S p . O U <br /> NUMBER OF DEVICES (rf lo�v vottage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if appticable) <br /> DESCRIPTION OF WORK: rl" '' �"t ✓ � a G <br /> CONTACT INFORMATION <br /> OWNER NAME: � TENANT NAME(If Commercial�: � <br /> OWNER MAILWG ADDRESS: siNeEr E� � � �,q <br /> cm Y11 �S✓1 srnTe V�/i i nr <br /> OWNERPHONE: �.S' 3 � ���3 OWNEREMAIL: n� �� en y�' �e <br /> +� <br /> CONTRACTOR NAME: OY' �i"T � <br /> CONTRACTOR ADDRC55; siaEer <br /> Gm• SiATE 21P <br /> CONTRACTOR PHON[: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.N�HEOuiRFD): CITY OF EVERETT BUSINESS UC.#(REaNRED): <br /> .. . _ _. . . ... . .. . .. . . .. . _. . . _ . . __ . . . <br /> PRI�7ARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑OTHFR(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> i�GREE,�7ENT. T here6y cerUly IfroH have mad and examined fhis appLcafron and hno�.v lhe same fu 6e true ard conecl. Alf pmvivons o�la�vs ond ordinances govertnng!ha <br /> lor.�I l.�r+mgulaf ng conslmcf on�o�fhe p�Ao�m�ae ol conslmchon�iha�I a n aulhonzed 6y 11 e o nerol Ih s pmP��Y 1�e�fo'rm Ih�woik!or which appl caGon�is mede an'dr� o' <br /> wmFY��','h;hc;fa;eCon;racloaL�r;ift77FCWantl296700WRC. <br /> Gty al Everelt 0/(icial Use Onty <br /> FEE <br /> ��� <br /> / PERMIT it <br /> � � � Ib- 15 E Irj (�- ORZ <br /> p�n dAutl ed Agent Signature Date (Revised 10/12/2015) <br /> / <br />