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CITY OF EVERETT PERMIT SES ES <br /> 3200 CEDAR STREET, EVERETT, uu>w 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECTADDRESS: <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 1P 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 ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: 5 z '"i%�' &;o i= <br /> CONTACT INFORMATION / <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: —TOWNER <br /> - EMAIL: <br /> � <br /> CONTRACTOR NAME: ���'t�b` `f'} V L�yLiLI (L <br /> CONTRACTOR ADDRESS: STREET <br /> CIN ,�~-•?✓!�,L d Nr� .l r19J STATE � - ZIP Ct <br /> CONTRACTOR PHONE: 1)(J C? 4( G ' ZZ,/ CONTRACTOR EMAIL: C1/rt L. r h e__wu.L e-1e_ctrit <br /> CONTRACTOR LIC.#(REQUIRED): R CITY OF EVERETT BUSINESS LIC.#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER PI-CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y jj�T <br /> CONTACT EMAIL: j G✓ <br /> i.;t�''_Ali d L'd.L: )i'C.✓Ll LS -3 -t�- 3'i L- <br /> i i S33 <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> z �rNil DU- dll <br /> Owner/Authoriz dAgentSignature Date (Revised 10/12/2015) <br />