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�CTF�ICA[� PEF�iVIIT AP��A`TION <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: �� � ��(�-(��y�..e��"� �i.Z�,( �-�i� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ 5FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: C`�COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � ��; 'J <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES F�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: (',�� � .� � f� <br /> �� ,S'�� '-�- <br /> CONTACT INFORMATION <br /> OWNER NAME: �i.t Y�-" G�,� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer �G '� j L � ;,��� .e�N" l'�C�� W� <br /> +�-- �� � ) � � <br /> CITY �� ' �'�L��{� STATE V�� ZIP �Y'/ <br /> OWNER PHONE: �� L � Z�� ' S � �) �l} OWNER EMAIL: <br /> CONTRACTOR NAME: :'� < � 1 <br /> CONTRACTOR ADDRESS: sTrteEr �'� i/�% �� �/-r <br /> CIIY ��.' /�7 STATE �.�-��" ZIP ' O .. <br /> CONTRACTOR PHONE: ��- - " '�-- �"��l� CONTRACTOR EMAIL: �C>I�, �"[ �". � c�L>�� C' jne�;-P, �-�v�.—� <br /> CONTRACTOR LIC.#(RECIUIRED): �,!-'"�� (AL � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Z j��C�z� � <br /> .. .__.._ __.. � _....._ ,_... ......... ... .. .. . _ __.___. __ ........ _ ...._,.. .. ......_� _... ... ...... ._ .._... _.. <br /> PRIMARY CONTACT: ❑OWNER ,�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �2, � � �� - v �C� � <br /> �� J` CONTACT EMAIL: (,t.�, � � — �,�, c� �,�,t«��J, c� <br /> AGREEMENT.�T hereby certrfy that l have read and examined this application and know the same to be frue and corr ct. All pro isions of laws and ordinances governing this <br /> type of work will6e completed whether specified herein or not The granting of a permit does not presume fo give authority to violate or cancel the provisions of any other state or <br /> loca/law regulating construction or the pertormance of construction. That I am aufhorized by the owner of this property to perform the work for which applicafion is made and I <br /> comply with the State Confractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> � <br /> PERMIT# <br /> E �--��Z� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />