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��,���'�I�A� �� I`� ,A�PI�I�.ATI� <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.gov/permits <br /> . , --- <br /> _ .� . ... <br /> ,_ . <br /> ; �ROJ��-r sv�r� s�vFORmA-r�o�v; ' � v'�n <br /> _ . . <br /> .. .._. . .. <br /> PROJECT ADDRESS: � �n \/2('C: v�/ dO ' WD y�S d. <br /> BUILDING AREA(if residentiai,new constraction,remodel,or addifion) � SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATfACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING; a, �� <br /> m ,. _. . . :, __ ,:.__ _,. _, <br /> �. ; ELECTRICAL.APPLICATIAN INFORMA°TIAN <br /> CONTRACT PRiCE OF WORK:$ 1 <br /> NUMBER OF DEVICES(ifi low voltage);� � <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: i � G� <br /> , . ... .. , . _ - <br /> . . . ., , .. .. <br /> -• � �CONTACT INFORMATION_. : _ . - <br /> OWNER NAME: TENANT NAME(If Commerciaf}: <br /> r <br /> OWNER MA(LING ADDRESS: srReer <br /> � qdCITY STATE � ZIP <br /> OWNER PHONE: OWNER EMAtL: <br /> CONTRACTOR NAME: G <br /> CONTRACTOR ADDRESS: s-rxeer e, 0. <br /> cin STATE z�P � <br /> CONTRACTOR PHONE: � -3 a - � CONTRACTOR EMAIL: t ' Y�(� � p� '' , V� <br /> . � _ <br /> CONTRACTOR LIC.#(REQUIRED): �G� g ��� CITY O EVERETT BUSINESS LIC.#(REQUIRED):�,� } <br /> PRIMARY CONTACT: 4C1 OWNER �CONTRACTOR ❑OTHER(Please Specify)� <br /> CONTACT NAME: CONTACT PHONE: a� - -�O <br /> _ ��,(���(Yl r,., V� � CONTAC7 EMAIL: ` l y`,1 � • � <br /> AGREEMENT.•T hereby certify that l have read nd examined this application and know the same to e t e and crorrect. AN provisions of/aws and ordinances governing this <br /> fype of work will be completed whefher specified herein or not. The granting of a permif does not presume to give aufhority to violate or cancel the provisions of any other state or <br /> local law regula6ng construcfion or the performance of construction. That I am aufhorized by the ownerof this property to perform the work for which application is made and 1 <br /> comply with the Sfate Contractors Law 98.27 RCW aad 298.200 W,9C <br /> City of Everet#Official Use Only <br /> FEE <br /> . �� • 4� <br /> PERMIT# <br /> � � � l � � ( ' � �� <br /> ,..� 1 I 6 <br /> Owner/A horized Agen ig Dafe (Revised 90/12/2096) <br />