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, ���c��i��� ���.�s� ����oc��so� <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: ��' - ,,-- �9 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 BUfLDING: �--j��� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ IZ L"y C-� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESC PTION OF WORK: C;�v • G'• -S n ,l cJ � / vi � <br /> . <br /> C v' .e -1 � c �-� v��+�.. ��t�- Q ra � 1----� C<� a v <br /> CONTACT INFORMATION <br /> OWNER NAME: -� � TENANT NAME(If Commercial): Z--C G' <br /> OWNER MAILWG ADDRESS: s-rReer �% 'Z_v L�/t:� O (; ' <br /> CIiY �V<..1� STATE Ll.�� � ZIP `� l--C� ( <br /> OWNER PHONE: OWNER EMAIL: <br /> _ <br /> _ <br /> CONTRACTOR NAME: . 'l � (c� '�-*�✓Z � C <br /> CONTRACTOR ADDRESS: sTReer I G�G ` ('C r�c: ;J-� : <br /> CITY ' /l� �/ ��I STATE � it ZIP <br /> CONTRACTOR PHONE: r---`-_ CONTRACTOR EMAIL: _ -- <br /> CONTRACTOR LIC.#(REQ ED): JY�� S S L�, _ CITY OF EVERETT BUSINESS LIC.#(REqUI ED): � <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � <br /> CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that l have read and examined this application and know the same to be frue and correcf. All provisions of(aws and ordinances governing this <br /> type of work will be completed whefher specified herein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any other state or <br /> /oca/law regulating construction or fhe pertormance of construction. That I am authorized by the owner of this property to pertorm the work for which application is made and I <br /> comply wrth the State Contractors Law 18.27 RCW and 296.200 WqC. <br /> City of Eve�ett Otficial Use Only <br /> FEE <br /> '�..g - Sb <br /> �.� PERMIT# <br /> y , Z 8' � -� E \�C�� —��O� <br /> O nerlA thorized Agent Signature Date (Revised 10/12/2015) <br />