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�����ac��� ������ ��a�a�a�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@evereftwa.gov� www.everettwa.gov/permits <br /> , - PROJECY SI"T� Ifi4�013iU1A`i'lON _ : , <br /> _ _ ._ <br /> PROJECT ADDRESS: � , ... , ? � . '� . ./ '. <br /> BUILDWG AREA(if residential, new construction, remodel, or addition) � ��- SF r' <br /> BUILDING TYPE: ❑ SFR-DETACHED C�7 SFR-ATTACHED ❑ DUPLEX ❑ MUL�"I-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> U5E OF BUILDING: ,�.�_l <br /> _ <br /> ELECTRICAL �PPLICA7'ION AIefFORMATION <br /> CONTRACT PRICE OF WORK:$ J �� ;����� ��- ���` � <br /> IVUMBER OF DEVICES (ifi low voltage): <br /> FIRE ALARM? 1�'YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � , � �� ;� :.,�_. � ���,,f c,� �ti j-- <br /> CONTACT INFORMATION ` ' . : <br /> OWNER NAME: � �� . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer ..,,,, {� - - r <br /> . <br /> / C.l t':- <br /> CITY � <-�` � STATE �//.��. ZIP :� ..i . <br /> OWNER PHONE:, �� ;, � �'C" ��'�,- - OWNER EMAIL: <br /> CONTRACTORNAME: - ��- � �� <br /> CONTRACTOR ADDRESS: srReEr (] 7 � ( <br /> CITY {r>_t „�.,-( STATE %-,.:'.�-. ZIP �, �, �.- �,- <br /> CONTRACTOR PHONE:�j;,i 'j ,.,L'ti> - �'�'j ` `�� CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REC2UIRED): � ' �-f��C� J�' CITY OF EVERETT BUSINESS LIC.#(REQUIRED):�7�" �r� <br /> . ,,_._:... .: _.__. ,� ...,.. _.._ _... ...:.... ... �_..<... ......... ....- _.. .. ,,..,. ... ...._.. ,...,,:. _.. _..,� _ ._..�.,-- -._.. ..:..._,.. - - - <br /> _.... �,. . .. _.._. ..... . _ <br /> PRIMARY CONTACT: L�WNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � <br /> CONTACT EMAIL: <br /> AGREEMENT.�T he�eby certify that I have read and examined this application and know the same to be true and correct. A/l provisions oflaws and ordinances governing this <br /> type of work will be completed whether specified he�ein or not. 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 pertormance of construction. That I am authorized by the owner of this property fo perform the work for which application is made and 1 <br /> comply with the State Confractors Law 98.27 RCW and 296.200 WAC. <br /> Cify of Everett Official Use Only <br /> FEE <br /> . ��� �% <br /> � <br /> � �� PERMIT# � �r <br /> � • � �U' <br /> i'� � � J <br /> / , ,� � /�-- i � �l b � <br /> Ow er/ thoriz AgerrtSigna ure Date (Revised 10/12/2015) � <br />