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�i����r�ic�� ����i� a���oc��io� <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: 1�j � � �f/-Z✓'��Tf 11.6� Iti`l� " <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 7��7� E SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> n <br /> USE OF BUILDING: }� 1i" <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ J ��-t% <br /> NUMBER OF DEVICES (if low voltage): ��C' <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ���a�t ✓�'CG' �/i'i . r�s-'" ��"w Tt. � ��'� �"i YCy� " <br /> �"6%-✓ �L� P ' � wit�l ���(i� � �CC:. <br /> CONTACT INFORMATION <br /> OWNER NAME: t"�' �V TENANT NAME(If Commercial): z'��'� <br /> OWNER MAILW G ADDRESS: sTReeT %Zf.7 j 5 �, �fh�i'r�" �lxJ �k�t, <br /> n �CfTY STATE M/ ZIP �` L� <br /> OWNER PHONE: �j�� �� 1 /�D� OWNER EMAIL: <br /> _. <br /> CONTRACTOR NAME: ,� i/ L ��f�!"�C �j�(/• `rl� ^ <br /> CONTRACTOR ADDRESS: srREEr t?G'!� %f � ��� <br /> CIN � 1 � STATE 4,/ ZIP `��� <br /> CONTRACTOR PHONE: �`r��) � j'�,'-3� CONTRACTOR EMAIL: �c �/l.t��+�1" c�i:lj'i`L-Sr(v'tl�4�B t.� ' �u�G� <br /> CONTRACTOR LIC.#(REQUIRED): !'�,"�` ' �7G�.Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED): '' I�I � <br /> . _.. _..:.. __......, . ...,..: _.... . ... _,., _.:..:.. __.._ _.,.:.:. �_-..,:. ... .�-_,.._ ..._._ <br /> PRIMARY CONTACT: ❑OWNER I'�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �j ��Z�j - SG j `E-� <br /> tiP �ZH" C (a,C �;,� CONTACT EMAIL: �� '�� -' ;,;,;• , L.� <br /> AGREEMENT.�T h by certify tha /have�ead and examined this applicafion and know the same to be true and correcf. AlI provisions of laws and ordinances verning this <br /> type of work will be compieted whether specified herein or nof. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and l <br /> comp/y with the Stafe Confracfors Law 98.7_7 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> L) �C' �— <br /> �� <br /> PERMIT# <br /> �-- j2-r<<�� E 1 �( Z. � C��C� <br /> Owner/Authorized Agent Sig re Date (Revised 10/12/2015) <br />