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��l�G��I� ��6� �� : �.➢��8�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98209 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/pf�rmits . . _ _ . PR�JEC7' SITE IM�OIiiliiA7'IOItI PRQJECT ADDRESS: '(;JS -�%J�C, S� BUILDING AREA(if residential, new construction, remodel, or addition) l�`C�1 �t°�� SF �, a CI G� � BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑CCMMERCIAL USE OF BUILDING: �-�G'd�L� ELECTRICAL APPLICAI'AO�d IMFORMAYION CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (ifi low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCiATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: (,�.1t, �"�}'� J��)C� ((Z1,Y �!I�.� �Jl�� L'l��C'� , , CONTACT INFORMATION _ : OWNER NAME: "; � � ",�}f y, � `1� U�/ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srrieer �G'JS �J�� CITY ^ �PI.Q� STATE �� ZIP ��' � O� OWNER PHONE: L�,:,��— ��U�� L�lf/�� OWNER EMAIL: �C_K�� L'� G _ . 7 CONTRACTOR NAME: ��iv�KN CONTRACTOR ADDRESS: sTReEr CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Pfease Specify) CONTACT NAME: CONTACT PHONE: � CONTACT EMAIL: AGREEMENT.�T hereby certify that/have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinance�governing this type of work willbe completed whether specified herein or not. The granting of a permif does not presume to give authority to violate or cancel the provisions o;'any otherstate or local law regulating const�uction or the pertormance of construction. That!am authorized by the owner of this property to perform the work for which applicatio��is made and 1 comply with the State Confractors Law 98.27 RCW and 296200 WAC. City of Evereit Official Jse Only FEE � � �l �O�O PERMIT# , �� J �� i�o3— I�"I �wn r/Authorized Agent Signature �ate (Revised 10/12/2095) u .