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� �1���`�RM�A� ���. l`� �P �A`�1� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8890 � FAX 425-257-8857 j (E) everetteps@everetiwa.gov� www.everettvia.govlpermits <br /> ,, ; .. . _. ,.. _... � . <br /> �. . . <br /> - - <br /> :, . . . � <br /> , . PR�.IE�T SI`�'E INF'ORI�AA'i'!0(el <br /> PROJECTADDRESS: �(� , S L� CV— s � 4 3 <br /> BUlLD1NG AREA(if re idenfial,new consfruction,remodel,or addifion)�'��' N� �� � �6� <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTf1CHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: [S I�[���j • <br /> .: -.. , . <br /> . _._. .. . <br /> � � ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ � <br /> NUMBER OF DEVICES(ifi low voliage):� <br /> FIRE ALARM? ❑YES �NO <br /> ASSOCIATED BUILDING PERMtT#{if appficable): <br /> DESCRIPTIQN OF WORK: ,[ % � " S <br /> . . . .. . , . .. . .. <br /> ' � � � .:CONTACT INFORINATION. � � <br /> OWNER NAME: � , TENANT NAME(tf Commercial): <br /> OWNER MAILING ADDRESS: sraee-r a.� <br /> �� n— <br /> CffY � �/ � STATE h� ZIP � � <br /> �WNER PHONE: y25 � OWNER EMAIL:�N D�, nSL� C� ,� �. � C� <br /> CONTRACTOR NAME: S <br /> CONTRACTOR ADDRESS: srReEr � <br /> CITY STATE � ZfP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> GONTRACTOR L[C.#(RE4UI ED): CITY OF EVERETT BUSINESS l.IC.#(REQUIRED): <br /> PRIMARY CONTAC7: OWNER y ❑CONTRACTOR ❑OTHER{Pfease Specify) <br /> CONTACT NAN1E: ��N� �i�;,�� CONTAGT PHONE: � <br /> 4 �2 ��Z, � CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cance!the provisions of any ofher state or <br /> loca/law regulating construction or the performance of construction. That!am authorized By the owner of this property to perform fhe work for which application is made and 1 <br /> comply wifh the Sfate Contractors Law 98.27 RCW aad 296 20o WAC <br /> City of Everett Official Use Only <br /> FEE <br /> . �s � <br /> PERMIT# <br /> - ,,�. 3 -2� ri � E j g4 3-l�� <br /> Owner/Auffiorized Agent Signature Date (Revised 90/92/2095) <br />