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����`��1��� ���Nil�' A���I��`�ION <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 /> PROJEC`i' SITE INF�FZMATION � <br /> PROJECT ADDRESS: '�%� ' „�'("�Ci� ,�— I ��� � ,) C�(,l��f�� ;�� �� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: s�/ V <br /> ELECTRICAL APPLICATIOM IPIFORMA'TION <br /> CONTRACT PRICE OF WORK: $ `�'` <br /> !/ I ' /L� � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: " ' j,�� ���C /,r' �Z.�' � 1--- � �JQ-�Z <br /> � <br /> � /2 . S �� 1 �� � �' G%� i21� L� 2 ls%��5� L-, <br /> _ ��� �- <br /> CONTACT INFORMATION <br /> OWNER NAME: I [�L L� � , � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP <br /> OWNER PHONE: l n (��� OWNER EMAIL: <br /> CONTRACTOR NAME: �� <br /> CONTRACTOR ADDRESS: s-rHeEr -,�} � � � � �Q <br /> ' � � <br /> cirr srATe , ^ ziP <br /> CONTRACTOR PHONE: � CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): ,� �� �� � � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):L�((lr � <br /> __. . __. <br /> PRIMARY CON7ACT: ❑OWNER ❑CONTRACTOR C�.2ffHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � Z� � � <br /> � � j�'1 � �� CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that l have read and examined this application and know the same fo be true and correct. A!l provisions of laws and ordinances governing this <br /> type of work wrll be complefed whether specified herein or not. The granting of a permit does not presume to give authorify to violate or cancel fhe provisions of any other state or <br /> local law regulating construction or fhe performance of consfrucfion. That l am authorized by fhe owner of this property to perform tlte work for which applicatron is made and I <br /> comply with the State Contractors Lav✓18.27 RCW and 296.200 W,4C. <br /> City of Everett Offrcial Use Only <br /> � FEE <br /> ��C� � <br /> �`;� PERMIT# <br /> � � �� � \ ro � <br /> / <br /> O ne AuthorizedAgentSignature Dat (Revrsedl0/12/2095) <br /> i� <br /> �� <br /> / <br />