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������'��� ��� i� � ���.��M� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425-257-8810 ( FAX 425-257-8857 � (E)everetteps@everettwa.gov� ww�nr.everettwa.gov/permits <br /> ...: ... <br /> , <br /> �, <br /> -:. <br /> - , PRO.lE�'1' SITE IN�'ORMA'i°dAM,: <br /> _:. . . _._:. . _.._ <br /> .. . . ,_ _ . . . <br /> _. _. _ . . <br /> PROJECT ADDRESS: � �� <br /> BUIl.D1NG AREA(if residential, new construction, remodel, or addifion) SF � <br /> BUILDING'i'YPE: FR-DETACHED ❑SFR-ATT/aCHED ❑ DUPLEX ❑MUL71-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: �� � <br /> _. <br /> .. _ -- <br /> . . . <br /> .,,. <br /> : , _::. , <br /> ' " - ELECTRICAL APPLICATION INFORMATION <br /> ... _ . <br /> _ __.. .. _ _ . . <br /> GONTRAC7 PRICE OF WORK:$ N, � Q � <br /> NUMBER OF DEVICES(ifi low voltage):� � <br /> F1RE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable); �}. <br /> DESCRIPTI�N OF WORK: �-�P A'� (/�1 1 N�- ��11`1 'E �'�(1�r b'11'E <br /> �1 i �'c - <br /> _ . : . , . ,. . . . <br /> � - <br /> ,; � �- CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commerciaf): <br /> OWNER MAILING ADDRESS: sraeEr <br /> C11Y STATE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR'NAME: H'�1��'ES C c`�Yl 1 .N � <br /> CONTRACTOR ADDRESS: srReer ti b�j "� � � S <br /> C17Y s�'�p�(l l/t, STATE � ZIP , �� <br /> CONTRACTORPHONE��IO ^ 9�-'�Jg ��„S CONTRACTOREMAIL: 1NY1 t �i,1��SCl"7Y1�T' p�Or <br /> CONTRACTOR LIC.#(REQUIRED): TY OF'EVERETT BUSINESS L1C.#(REQUIRED). � <br /> .,.�.�..K...-�..a,..v..�W...�,N..,.,...�.,._.,n.�..,..,..«.,. .. .....r.�.a� ..,..,�.. ,.� .......��v,_....,.„.... _ .,>,W.�. �. _ ,.»., . <br /> PRIMARY CONTACT; ❑OWNER LL�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTAGT PHONE: �.—"'�'� -- �j � <br /> ��� . <br /> ', �m CONTACT EMAIL: � ° h ti <br /> i <br /> AGREEMENT.-T hereby certify that l have read and examined this application and know the same to e true and correct. Al!provisions oflaws and or inances governing this <br /> type of work will be completed whetherspecified herein or not. The granfing of a permit does not presume to give authorify to violate or cance!the provisions of any other state or <br /> loca!iaw regulating construction or the perfo�mance of construction, That l am authorized by the owner of this property to perform fhe work for which applicafion is made and 1 <br /> comply with the Sfate Contracfors Law 98.27 RCW and 296.200 WAC. <br /> CiPy of EveretF Official Use Only <br /> FEE <br /> �� �_ <br /> �'" , ,:'"' PERMIT# <br /> := ,� �� E �.�02 - �2� <br /> Owner/ t orized Agent Signature Date (Revised 90/9?J2015) <br />