|
��� ���� �� �� �. ��c.����
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-889 0 � FAX 425-257-8857 j (E)everetteps@everettwa.gov� www.everettwa.gov/permifis
<br /> . .... .
<br /> ...
<br /> ,.
<br /> . ;
<br /> _ PROJEC`f S17'E OMFORM,A,TION; .
<br /> _ .__ .. _ .. . _. .
<br /> PROJECT ADDRESS: � �n 1}' � GLI.
<br /> BUILDING AREA(if residenfial,new consfruction, remodel, or addition) SF �
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-A7TACHED ❑DUPLE?C MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: �� _ -
<br /> - , .. ... _::.. .,..- ..:_ . .,.
<br /> ELECTRICAL APPLICATION IN.FORMATIQN
<br /> ... . ...: . .. . :... .. _.. . _.. ... . .
<br /> :. . .. _... _.. .. . .. . . ..... ... _ . . ...
<br /> CONTRACT PRICE OF WORK:$ C� " ,� �f (��
<br /> NUMBER OF DEVICES(ifi fow voltage);�
<br /> FIRE ALARM? ❑YES O
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCR[PTION OF WORK: ^ � � �
<br /> � � �� S �� L O �l�I/�S � -
<br /> : , , ... .. . . � . .
<br /> . _
<br /> -• CONTACT INFORMATION.. .
<br /> OWNER NAME: TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: s~r�eEr / I,�-• �� I
<br /> � CITY STATE ZIP ( �
<br /> OWNER PHONE: OWNER EMAIL:
<br /> .� . .,. . . .. ... . _.... .. .. .... . . . ... . .. ... .. ... . . . ....,,. �. . . ,
<br /> CONTRACTOR NAME: � {;(„
<br /> CONTRACTOR ADDRESS: s�eEr �j �C:l � �B�
<br /> CIN STATE ZfP �
<br /> CONTRACTOR PHONE: - � CONTRACTOR EMAIL:� �� � r �'LI
<br /> CONTRACTOR LIC.#(REQUIRED): L��� CITY OF EVE ETT USWESS LIC.#(REQUIRED).
<br /> ��.,....,.�.._.<>.,�....,�.�=R.....�M,�.,�,.-.�.4.,_-.�-._.,:a-.:.... ,...,.�,........r,�,,.,,:...,.�-..r_....,...............���....r...,....,.....,..,.>.Y,�.....�r.-n-,.�».,�...�,��.:>...-��r - - _
<br /> .-�,�.�.a�:wwH>.-w.....u,l.,Y-v�.�. �.:......,...�... ..wn.�__..„..,.r,..,.._,....,. ,
<br /> PRIMARY CONTACT: ❑OWNER �'CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: -2 �/.
<br /> �� CONTACT EMAIL: � �
<br /> AGREEMENT.�T hereby certify tha I have read and examined this appiication and know the same to be true a rrect Ail provisions oflaws and ordinances governing fhis
<br /> fype of work wil!be completed whether specifred herein or nof. TF�e granting of a permif does not presume to grve authority to violate or cancel the provisions of any other state or
<br /> loca!!aw regulating construction or the pertormance of construction. That l am authorized 6y the ownerof this property to perform fhe work for which application is made and!
<br /> comply with the Sfate Contractors Law 98.27 RCW and 296.20o WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> � � s �
<br /> PERMIT#
<br /> - . 2� , � ���� - l l��
<br /> Owner horized Agent Signature Date (Revised 90/12/2095)
<br />
|