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�L��TRI�A� �� [�itl`� ,A�P1�1CAT1� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER�TT, WA 982D9 <br /> (P)425-257-889 0 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> IP1t�JE6"f SI`i°E IN�'QRMA'I'IAN �'. :L.O („��►<►�l .�� _ . — <br /> . ..:..:.._ ._:.,:. _. ... . _::: _.,: .. . .. . , ..;. ,,_ . <br /> PROJECT ADDRESS: � � — 1 b 0�Q I7 e�n " . <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATi'ACHED ❑DUPLEX ❑MULTI-F/aMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING. � <br /> _. <br /> . ._ ,. . -., <br /> ELECTRICAL i#PPLICATION INFARMA'TIORI ' <br /> CONTRACT PRICE OF WORK:$ ' <br /> NUMBER OF DEVICES(if low voltage):� <br /> F1RE ALARM? ❑YES [d0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> QESCRIPTION OF WORK: , � �� <br /> , , - .: « . .:: .. . : . . .. .... _:. ._ . .. - <br /> . , . <br /> ; :�: <br /> - <br /> _ , <br /> .:. . _ : ::�: . .. ,CONTACT:INFORMATION. .: <br /> OWNER NAME: TENANT NAME(It Commercial): <br /> OWNER MAILI(JG ADDRESS: sTaeEr <br /> � O� �e � <br /> CITY �VI.�Ci ' STATE � ZIP � O <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: G <br /> CONTRACTOR ADDRESS: sraeer <br /> cirr e sTA� zaa � <br /> CONTRACTOR PH�NE: `� � CONTRACTOR EMAIL: � 1 r L U✓1� <br /> � ,� ._ . <br /> CONTRACTOR LIC.#(REQUIRED): �V� G(�� C[7Y OF EVERETT BUSINESS LIC.#(REQUIRED): OS �a� <br /> _,�..,_....�„�...,�...n,.._�m..,,...��..,_._Y_�......,,....,�,...a�,.....�,.�T.,..,,.,�.s........,.�... a <br /> PRIMARY CONTACT: ❑OWNER ��Q CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAIVIE: CONTACT PHONE: � — <br /> � CONTACT EMAIL: ` � L � <br /> � � �� <br /> AGREEMENT.•T hereby certi that!flav read and examined this application and know the same to be e and correct. All provisions of laws and ordinances goveming this <br /> fype of work will be completed whether specifed herein or not. The granting of a permit does not presume to give aut6ority to violafe or cancel the provisions of any other state or <br /> locallaw regulaSng consfruction or the performance of constnrction. That I am authorized by fha ownerof this propertyto perform the work for which application is made and! <br /> comply with the Sfate Contractors Law 98.27 RCW an.d 296 200 WAC <br /> City of Evereit Officia!Use Only <br /> FEE <br /> . ��� <br /> PERMIT# <br /> ..,.� 1 I J6 �I�1 � `7 ll � � �� <br /> Owner/Aut orized Agent gnature Date (Revised 90/12J2015) <br />