Laserfiche WebLink
������o��� ����o� ���d������ <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.everetfwa.gov/permits <br /> PRO�IEC7'S17'E li�lFOR�ll�►7'IOQ� : _ <br /> PROJECT ADDRESS: 2�1� L t�p�i� `�-� C �, �,u?�:- c-� `1 �'���. �, <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDWG: <br /> ELECTRICAL APPLICATION 9IVFORMATION <br /> CONTRACT PRICE OF WORK: $ �c:c.: <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: "���'v�(� �_� �: ��t— <br /> _ : . <br /> ' CONTACT INFORMATION ' <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srr�eEr <br /> CITY STATE ZIP <br /> �WNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �v.� , o `;�:�� L� L <br /> CONTRACTOR ADDRESS: sTReeT t � �C �; S'�ft-��C r ����`� <br /> CITY L,"r�i��V'`;C%' STATE l��.i f�' ZIP �� <br /> c <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: Z ��i1�Z�� �� -t��'���uc,N���- Llrc. ��vr <br /> CONTRACTOR LIC.#(REQUIRED): A�\O\c:c: L�� -- (0 7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): G 5 5 �-�- �3 <br /> PRIMARY CONTACT: ❑ OWNER �:CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �v C�� ,�Z`1 ��;`>� C% <br /> <- t'��1 L"-+�-- <br /> CONTACTEMAIL: �t�NP2 C'- Au� ������� ��-L �= ' ��> ,"' <br /> AGREEMENT.�T hereby certify that l have read and examined this application and know the same to be true and correct. A!I provisions of laws and ordinances goveming fhis <br /> type of work will be completed whether specified lierein ornot. The granfing of a permit does not p�esume to give authoniy to violate or cance!the provisions of any oti�er state or <br /> local law regulating construction or the performance of construction. That!am authorized by the ov✓ner of this property to perform fhe work for which application is made and l <br /> comply with the State Contractors Law 1827 RCW and 296.200 WqC. <br /> Cify of Everett Official Use Only <br /> FEE <br /> � r i ��tC-'C'/ <br /> � <br /> � <br /> / PERMIT# <br /> � ----' � �'��'� ' ��l I <br /> O er/A�f orized Agent Signature Date (Revised 10/12/2015) <br /> / <br />