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� � <br /> ���������� ����'� ����,I��,���� <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 /> PRO.IECT SITE INFORMA�'ION <br /> PROJECT ADDRESS: �� %,f��% � � %��' � >.' ��� � r�,.����f� � �` �'� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: �0 COMMERCIAL <br /> USE OF BUILDWG: ' ;� � � i <br /> ELECTRICAL APPLICA7'ION INFORMATION <br /> CONTRACT PRICE OF WORK: $ :� i;' % ' '"- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK. ��' � ! � � � �-� ' � �'�r �� <br /> f._ <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: ` � � - �� �`j�;jr'� '!-+- ' TENANT NAME(If Commerciai): �{,,��` f� ,�.r_. t` �::-/• <br /> OWNER MAILING/ADDRESS: � sTReer �,',-� ��" �� - " r'.�-�' ;��� 1 _;��'� ` ( �.�f` �'��� <br /> a--- �� � <br /> - �.�/. ;.%,�'`�- CITY STATE s���/� ZIP � f-.�'�,.-. <br /> OWNER PHONE: � --.�J J l OWNER EMAIL: r � '�,/' � • � -:-�'` .; <br /> „ / _ <br /> ,P�; r, "�, i � 1 � '._/ � 4 <br /> CONTRACTOR NAME: � .� � ' / ��:; ,. ";�.�. �,; /. �! t .,"_�•� .. <br /> CONTRACTOR ADDRESS: srReer .� = �' i�I���� '' � � � <br /> > <br /> J � /, �„��' ��: � CITY STATE �`���f�. ZIP , � <br /> CONTRACTOR PHONE: .'�.� • CONTRACTOR EMAIL: -�: r` ' !�.�'._ /• ' ' ''.'�.'' y� � <br /> : C�— <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED L��-F+ <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ' ,, '� �' - ` r ,: � <br /> %. . C.'�' � CONTACT EMAIL: �., i ` � ` '' ;�� ' � � , . � <br /> .. ',— <br /> AGREEMENT. T hereby certify that 1 have read and examined this application and know the same to be frue and correct. AIl provisions of laws and ordinances governing this <br /> fype of wo�k will be completed whether specified herein or not The granting of a permif does not presume to give authoiity to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. Tl�at!am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the Sfate Contractors Law 18.27 RCW and 296.200 WqC. <br /> Crty of Everett Official Use Only <br /> FEE <br /> ���- - so <br /> � <br /> PERMIT# <br /> ` � `� c ` � �� <br /> Owner/Auth ized Agent Signature Date (Revised 10/12/7_015) <br /> % <br /> ,i <br />