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_������/�� ������ �����,����� <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> jP)425-257-8890 � FAX 425 257-8857 ) {E)everetteps@everetfwa.gov) www.everettwa.govlpermits <br /> , _ . . _. _ _ ,-� - - <br /> ,._ <br /> , _._ . <br /> ' PROJECT SITE INFORMATION' ' <br /> . ., _ . . :... __._. ... .... ,. .. .. :: <br /> , . ._:_-. � _ .. .... .. . .._ . . , . . .. . .. . . _. .. . , <br /> PROJECTADDRESS: q 3C�s} '� ��� , '1 _ � ?j <br /> W <br /> BUILDING AREA{if residential,new construction,remodel,or addition) SF ' <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACNED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: ��y� �� � ;� <br /> ,. _.. _ , <br /> .- <br /> -- <br /> ' '.: ELECTRICAL APPLICATION WFORMA`i'ION: _ <br /> GONTRACT PRICE OF WORK:$ • <br /> NUMBER OF DEVICES(ifi(ow voltage):� <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUfLDING PERMIT#(if applicable): <br /> DESCRIPT(ON OF WORK: � � l <br /> , , . .. .., ,. . _ . _ <br /> ._ , . .... . . � ._ . . . . . .. <br /> ,,,. .. . <br /> . . .:�- . <br /> . <br /> - � .... , .: :CONTACT INFORIIAATION. _; _ <br /> OWNER NAME: � ; , TENANT NAME(If Commercial): <br /> OWNSR MAILING ADDRESS: srneEr ��, <br /> �c'���r S� <br /> Cf1Y �i+� � STATE VI,�G ZIF C� 3 <br /> OWNER PHONE: ( qq, � OWNER EMAIL:'� �c� ;\,1 .� �,�jp , y�.� <br /> CONTRAC70R NAME: � <br /> CONTRACTOR ADDRESS: sTaEer Q C�.bk'g� <br /> CITY �^ C��— STATE � � ZIP �� <br /> CONTRACTOR PHONE:1-�,�`j���q�� � CONTRACTOR EMAIL: " <br /> CONTRACTOR L[C,#(REQUIRED): (��� CITY OF EVERETT BUSINESS LIC.#(REQUfRED): �C <br /> PRIMARY CONTACT: ❑OWNER ❑CQNTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAM�: CONTACT PNONE: 1�,�-2�(�`-��$� � <br /> e CONTACT EMAIL: :��.� ; `� �� � � ,�� <br /> AGREEMENT.�T hereby cerfify fhaf I have read and examined this application and know the same to be true and rrect. Al ovisions oflaws and ordinances governing thrs <br /> type of work will be completed whether specified herein or not. The granting of a permif does not presume to give authorify to violate or cancel fhe provisions of any other state or <br /> local law regula6ng consfrriction or the performance of construction. That l am authorized by the owner of this propeity to perform fhe work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC <br /> City of Evereit O�cia!tlse Oniy <br /> FEE � <br /> . �pb a�� <br /> PERMIT# <br /> � ( � "�" � 1� �o�"' !�� <br /> OwnedAuthorized Age ignature Date (Revised 90/12/2095) <br />