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��.��TR1�A� ���. 1�' ,A��L IC�`���N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 j (E) everetteps@everettwa.gov� www.everettwa.gov/permits <br /> _ __. <br /> . ,:, _._ < . .. <br /> , ` _ PROJECT SI°i°E II�I�ORi1AAT1OIV': - <br /> � . . _. . . ... . <br /> . _ <br /> PRQJECT ADDRESS: �� 3 � C_._.G��� - QJ� �� ,� �ei��rT ►� q, e��� <br /> BUILDIIVG AREA{if residenfial,new construction,remodel,or addition) SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR- ACHED DUPLEX ❑MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILD[NG: //e�,� T ,4 vf=j4-C�%/�I� � <br /> _. ,. :. .. -- <br /> _ , . , . <br /> ` � ' E ECTRICAL APP ,ICATION INFORMATION <br /> . . . . _ ... _. . .. _. . .. . <br /> CONTRACT PR10E OF WORK:$ D �d � � <br /> NUMBER OF DEVICES(ifi low voltage);� � ,] <br /> FIRE ALARM? �YES ❑N <br /> ASSOCiATED BUILDING PERMIT#(if applica <br /> DESCRiPT10N OF WORK: ���O �.4 f2 h� P� w Q L 1e �'�L/a-�'F m-� �v� <br /> �� � - <br /> . _ . .: ... . . . _ _ <br /> _: <br /> . _ . . ... ;: , :.. ,CONTACT�INFORMATION.. . <br /> OWNER NAME: s�"�-��C,��� S' TENANT NAME(If Commerciat): �j D E' //1J G <br /> OWNER MAILING ADDRESS: srReer �6 IJ� � � � �5 <br /> CITY � (/r,f Up�/V . STATE ls�✓ "'" ZIP L�Q / l <br /> OWNER PHONE: o� �3 / � �G�G OWNER EMAIL: � r/e L�/� j� Sc� ?�'ONI c s� �D m <br /> CONTRACTO.R'NAME: r��''/��T(nlJ f"V I C S <br /> CONTRACTOR ADDRESS: srReEr �� �C�X �� 3� <br /> cirr �U�J U dP/�U STATE l/t �-f ziP O <br /> CONTRACTORPHONE: J� �j '�"J,3/ ,IOGO CONTRACTOREMAIL: ,�F'?E'� � Q -S�A-T�'QlV/C� �/��`-'<<'C� <br /> CONTRACTOR L[C.#(REQUIRED}:��'Q T�� � 07 C�i`-� CITY OF EVERETT BUSINESS LIC.#(REQUfR ): /r�7o� <br /> PRIMARY CONTACT: raK�OWNER Y(�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAN1E: , CONTACT PHONE: �" �j C7 �j � (p(,? �, � � <br /> ���e f� ��b/D�/ G � CONTACT EMAIL: <br /> AGf2EEMENT.-T hereby certify that I have read and examined this applicaSon and know the same to be frue and correct. AU provisions oflaws and ordinances governing 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 other sfate or <br /> local law regulating construction or the performance of const�uction. That!am authorized by the ownerof this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> City of Everett Official Use Onty <br /> FEE <br /> • ��O ��- <br /> PERMIT# <br /> _ � ��t2 - c�2 <br /> r <br /> ' �- � �ai'] <br /> Owner/Authorized Agent Signafure Dafe (Revised 10/1?J2095) <br /> ( <br /> . (� <br />