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��cr�ic�� �ERn�e� �Lic��-ion� <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 /> PROJECTADDRESS: �L� -j,. ,�,_j���G:�iv ��i�k� ��J�/s�.':'%j � G ' �;, � <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: C�COMMERCIAL <br /> USE OF BUILf71NG: ,(,�L�(�,•+<L S a <br /> ELECTFtICAL APPLICATION INFORMATION <br /> � <br /> CONTRACT PRICE OF WORK: $ 7 7. � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES �NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: � `� '�!�SL'f <br /> � , "j� <br /> Z�- �iJ �,'1'.,��L <br /> CONTACT INFORMATION <br /> OWNER NAME: �,�M L�i�Z-1�- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT C,�J a�� l�•���e:X:.'s+ i¢i'� <br /> n, �y v��j,9�, <br /> CITY �L'L2L%�T STATE �/" ZIP C��L � <br /> OWNER PHONE: yL•�-YG�� 35 35 OWNER EMAIL: � Ih��`"4i�t-''� � (,�'/�( � �s� (,!5.'q • �U/�'� <br /> _ _ _ _.. _ _. _ . . _ _ <br /> CONTRACTOR NAME: r � �L l cL'�[L C_ d G '�Cy��l• (✓�/!e'�1 <br /> CONTRACTOR ADDRESS: srReEr llL1 r. �/ L�t�. <br /> CITY N�;� •�� � �•� L7 STATE ZIP <br /> CONTRACTOR PHONE: C� 0`'� � CONTRACTOR EMAIL: �� <br /> ,. � I: S ct. .= ' G• ;�[, .. �� <br /> CONTRACTOR LIC.#(REQUIRED): ��� �L<= � L � � "'� A CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O Z ZJ S <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: •• ��� � ���cU <br /> �'�� ��� CONTACT EMAIL: 4,� � �' �_ , r <br /> e- UL l4c ¢. rc_ . 4--� <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be tr and correct. All provisions of laws and ordinances goveming this <br /> type of work will be completed whether specified he�ein or not. The granting of a permit does not presume fo give authonty to violate or cancel the provisions of any other state o� <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which applicafion is made and I <br /> comply with the State Cont�actors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett OKicial Use On/y <br /> FEE <br /> �������� <br /> , <br /> > <br /> PERMIT# <br /> � l Z ��� E � �� J� �' " '= <br /> �_; <br /> Owner/A orized ent ignature `� Date (Revised 10/12/2015) <br />