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=��TRICAL �ERtV�I� �I LI�A`TIO� <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 IWFORMATIOPf <br /> PROJECT ADDRESS: � 2,� `���-�'"'�- >�- ��<� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �I COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION i <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: �� [��N��'�. ,_-�L�- � rn����..}.� -- <br /> CONTACT INFORMATION <br /> OWNER NAME: '� �' ' j ( �TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReET 3(UZ, �� �`� <br /> CI-IY ' � ����� STATE �1� ZIP ���CS-J J <br /> OWNER PHONE: -_ - OWNER EMAIL: <br /> _ . _ __._. _ _.. .. <br /> CONTRACTOR NAME: ' ' ' �.� � � � = �� � ��L, C� <br /> CONTRACTORADDRESS: s�ReeT ��O I�U�C � <br /> CI IY � �J`�(�� J ' � � STATL= � [„_.J ZIP <br /> CONTRACTOR PHONE: –�j� CONTRACTOR EMAIL: <br /> CONTRACTOR LIG#(REQUIRED). � �j �� � �- CITY OF EVERETT BUSINESS LIC.#(REQUIRED):��'�� � <br /> PRIMARY CONTACT.:,..:❑ OWNER �,CON ._ ........ _........ _ . _.... ,..__, .. __ .... _. <br /> TRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: �� CONTACT PHONE: ��y— �,t�� f <br /> / <br /> CONTACT EMAIL: <br /> AGREEMF_NT:T hereby cerfify 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 <br /> type of work will be completed whether specified herein or not. The g�anting of a permit does not presume to give authority to violate or cancel the provisions of any other stafe or <br /> local law regulating const�uction or fhe peiformance of construction. Thaf I am autho�rzed by the owne�of this property to perform the work for which application is made and l <br /> comply wifh the State Contractors Law 1 f3.27 RCW and 296.200 WAC. <br /> City of Everett O�cial Use Only <br /> FEF_ <br /> _ l� -�� '� <br /> PERMIT# <br /> — � /� � ,-� � �e � z� r <br /> � � <br /> Owner/Au gent Siynature Date (Revised 90/17J2095) <br />