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CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425-257-8890 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction,remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED aSFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES E1 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: - SCI 1J <br /> Q <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z�2 S L <br /> CrrY STATE t ZIP 215203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: M U ��� ON`j L <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE V'VI�'! ZIP VZ, /Q <br /> 6 <br /> CONTRACTOR PHONE: ,ICrO�1NTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): P �S ��ul v CITY OF EVERETT BUSINESS LIC.#(REQUIRED): J <br /> PRIMARY CONTACT: ❑OWNER 137 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> J M�E- CONTACT EMAIL: <br /> AGREEMENT..Thereby certify that/have read and examined this application and know the same to be true and correct. All 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 authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 tom,% <br /> PERiMIT#f <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />