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,��������/16 ��I�IY1�� �� e ��l�Aw���l'V <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 /> PROJECT ADDRESS: � � (� ? �3 �-Z � -t�- <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 'SFR-DETACHED ❑ SFR-A�ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ��,=,,'��,v� i'-� � • .ti'� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: �'i' � GCi'� - <br /> NUMBER OF DEVICES (if low volta - —� ' <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: („�� % IG ' � �C�2 --I � � �/� <br /> ^ , <br /> � - .. .� � �z- <br /> CONTACT INFORMATION <br /> OWNER NAME: ` ,� � �� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rREEr �C� L I � �tLL S`�` <br /> � � f <br /> - �-�-�n� CITY �/" � STATE ZIP <br /> OWNER PHONE: 0 � �-1 Z'Z I��� OWNER EMAIL: /{ <br /> _ . _ _ <br /> CONTRACTOR NAME: •O w�n ��`l—'i `�" ��L��"�� S"��'� `� L C- L <br /> CONTRACTOR ADDRESS: srReeT , Q , l7c � L� Z <br /> 6�O`^�S � CITY (�✓ (� STATE � �Z � � Z�p <br /> CONTRACTOR PHONE: �G 5C� �y sy CONTRACTOR EMAIL: �C-��h ?�� � � :'w�'� <br /> CONTRACTOR LIC.#(REQUIRED): C O � �r—' �S ��� .J � CITY OF EVERETT BUSINESS LIC.#(RE D): S <br /> . _:..:_,, _., _.:.. _..,,._. . ,,.,,.. _. ..... .._, __ _.,._. _..... _...:_.._ ... ,._. .._ ... _... . <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) — ---- <br /> CONTACT NAME: CONTACT PHONE: 6� �Z-Z- �� <br /> �j � I 1 �,��j i��"'�� CONTACT EMAIL: G p,,.� �,"�'e � � C� L <br /> t <br /> AGREEMENT.�T hereby certify that I l�ave read and examined this application and know the same to be true and correct. All provisions of laws an' rdinances governing tl�is <br /> type of work will be completed whether specrfied herein or not. The granfing of a permit does not presume to give authority to violate or cancel the provisions of any ofher state or <br /> locallaw regulating consfruction or the performance of construction. Thaf I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply wifh the Sfate Confractors Law 18.27 RCW and 296.200 WAC. <br /> City of Evereft Offrcial Use Only <br /> FEE <br /> �O� �^ - -- <br /> ,/ �/ PERMIT# <br /> : � , <br /> ' � �/ � � E �� o � -- C�S� <br /> Owner/AuthorizedAgentSi �fure Date (Revisedl0/i2/2015) <br /> %.. <br /> j/ <br />