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<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.govJpermits
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<br /> PROJECT ADDRESS: �2� �� S � � � � .e, V
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) � � SF �
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX MULTI-FAMILY-#OF UIVITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
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<br /> ELEC"�'RI,CAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ O �
<br /> NUMBER OF DEVICES(ifi low voltage):�
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERM(T#(if applicable):
<br /> DESCRiPTtON OF WORK:
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<br /> . ._ _ . .. CONTACT I,NFORMATION
<br /> OWNER NAME: �p� �j ' TENANT NAME(If Commerciaf):
<br /> OWNER MAIL.ING ADDRESS: s-rHeer
<br /> CRY STATE ZIP �
<br /> OWNER PHONE Z'{'C> g2 - ���S� OWNER EMAIL: � fi� �S � \�o G�V�
<br /> CONTRACTOR NAME: �` \ �W � �
<br /> CONTRACTOR ADDRESS: sTReer �5 Q� I�G�h �SI- �'IO3 '
<br /> c�n ("`� CV�Lk STATE�J ' ZIP�
<br /> CONTRACTOR PHONE: 1 1�� �-I�`� �� CONTF2ACTOR EMA(L:—f }��''Fl \�o G W�
<br /> CONTRAC70R LtC.#(REQUIRED): ����' ..�V{a, �j�]IZ I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �IT��
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR �OTHER(Please Specify) �C.\ � �$-���
<br /> CONTACT NAME: CONTACT PHOIdE: �"I2Cj �j��- '7�G1 b .
<br /> � � �/ G CONTACT EMAIL: ''� ���`��������p Gd(�/�
<br /> AGREEMENT.•T hereby certify thaf I have read and examined this application and know the same to be true and correcf. AU provisio�s oflaws and ordinances goveming 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 otherstate or .
<br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform fhe work for which application is made and 1
<br /> comply with the Stafe Contractors Law 98.27 RCW and 296.200 WAC.
<br /> City of Evereit Official Use Only
<br /> FEE
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<br /> PERMIT#
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<br /> Ow uthorized Agent Signature D fe (Revised 90/92/2095)
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