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L PERMIT ERMIT APPAATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3-? �M A -T-S f �[v <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED El DUPLEX ElMULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: , SA-C <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? aYES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: r'? t r �.�� <br /> od C Z ) r` t x <br /> r <br /> CONTACT INFORMATION <br /> OWNER NAME: r+"' j" o/ ; JI TENANT NAME if Commercial). <br /> OWNER MAILING ADDRESS: STREET g '`A <br /> CITY V STATE (/\/ ZIP <br /> OWNER PHONE: Yl-S 7- OWNER EMAIL: <br /> CONTRACTORNAME: <br /> CONTRACTOR ADDRESS: sTREEr U00 o Y t <br /> t CIT-Y7 STATE ZIP <br /> CONTRACTOR PHONE: ZJ y07- Or J?Z-- CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): !1! CITY OF EVERETT BUSINESS LIC #(REQUIRED) �ZZ <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: f}'�/� CONTACT PHONE: 2 - -7 Z.2- <br /> C� / D !ut t/s CONTACT EMAIL: , , t <br /> AGREEMENT:T hereby certify 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 ornot. The granting of a permit does not presume io give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296,200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> �V <br /> I a � <br /> PERMIT# <br /> 5:c, le <br /> o- erfA, orized Agent Signature Dato (Revised 10/122015) <br />