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������f�/�� ������ �L.��.����� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI-I�, WA 98209 <br /> (P)425-257-8890 � FAX 425-257-8857 � (E)everetteps@evereftwa_gov� www.everettwa.gov/permits <br /> :. _ ,_. .. ., : _ _ <br /> , _ <br /> � PROJ�CT SITE INFORMA,TION' <br /> PROJECT ADDRESS: CC ��, <br /> BUILDING AREA(if residential,new construction,remodel, or addifion) SF ' <br /> BUILDING i'YPE; ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: � <br /> , ,,.. _.. -., .-. --.,. <br /> . . _ - <br /> ' ELECTRICAL APPLICATION W�ORMATIOI�i: <br /> CONTRACT PRICE OF WORK:$ • <br /> NUMBER OF DEVICES(ifi low voltage):� <br /> F1RE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicabie): <br /> DESCRIPTION OF WORK: Y1�1 {� � � �. �T <br /> . ._ ...,_ , . .... ... . . _ <br /> : . ... . <br /> ; :' . . ,.. -.: _. . :.: ,:.;CONTACT,INFOR,NIATION.. ::., . � � - � -- <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWfVER MAfLING ADDRESS: s-rFtee-r <br /> CI'iY STATE ZIP <br /> OWNER PHONE: �jC'�•—� �� OWNER EMAIL: <br /> CONTRACTO:R NAME: � ' <br /> CONTRACTOR ADDRESS: s-rReer • <br /> CITY STATE ZIP I <br /> CONTRAC70R PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED}: CITY OF EVERETT BUSINESS LIC.#(REQUfRED): , <br /> PRIMARY CONTACT: ❑OWNER Y ❑CONTRACTOR ❑OTHER(Please Specify)� <br /> CONTACT NAM�: GONTACT PHONE: � <br /> = CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that I have read and examined this application and know the same to be true and correct AH provisions of laws and ordinances goveming this <br /> fype of work will be completed whether spec�ed herein or not. The graoting of a permiE does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulaSng consfmction or the pedormance of construction. That!am authorized By the owner of this properfy to perform the work for which application is made and I <br /> comply�vith the Sfate Contracfors Law 98.27 RCW and 296.200 WAG. <br /> Cify of Everett Official Use Only <br /> FEE <br /> � � ����'/ <br /> PERMIT# <br /> � �o / EI�D�rl�11 <br /> 0 er/Aufhoriz dAgentSignafure Date (Revisedl0/12/2015) <br />