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������i��� �� �� � �����» <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P}425-257-88'10 � FAX 425-257-8857 j (E) everetteps@everettwa.gov� www.everettvia.govlpermits <br /> ,. <br /> = ' PROJE�T SI"t°E INF012ti�ATlOd+1'': <br /> P120JECT ADDRESS: �' Q� �, <br /> BUILDIIVG AREA(if residential,new construction,remodel, or addifion) SF � <br /> BUILDING TYPE: ❑SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-F'AMILY-#OF UNITS: ❑COMMERCIAL <br /> US�OF BUILDING: �{ <br /> , ... . <br /> _... <br /> ELECTRICAL APPLICATION INFORMATIAIV J <br /> CONTRACT PRiCE OF WORK:$ � <br /> NUMBER OF DEVICES(ifi low vo[tage):� <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOClATED BUILDING PERM17#(if applicable): <br /> DESCRIPT(O[V OF WORK: �"�? <br /> . ._. :.. _ <br /> ... . . <br /> :. . <br /> • <br /> , . = CONTACT:INFORMATION ; _ <br /> , _. . .. . - - .. ._ _... . . . . . <br /> OWNER NAME: �1� �'(�(,� TENANT NAME(If Commerciafj: <br /> OWNER MAILING ADDRESS: s-rReEr �j' �D� QI�0�' ST S t- <br /> ��N .��f-9- STATE �� Z,P `�ga o� <br /> OWNER PHONE: � � �jO OWNER EMAIL: (�O�1Q,I Ie I �.�OD ,• C�WI <br /> CONTRACTOR NAME: q, � C!�{Y"l�Ci �C <br /> CONTRACTOR ADDRESS: sTReer t /J� <br /> cirr l/ c1T�'�'N STATE Z(P � <br /> CONTRACTOR PHONE: "lZ� �.� `/ �-] CONTRACTOR EMA(L: q,�(Q, S t'� Ci1 /� � GVl ar� . �Wl <br /> CONTRACTOR LIC,#(REQUIRED): 'E �(t�C CITY OF EVERETT BUSWESS LIC.#(REQUIRED): j,5L/gO <br /> PRIMARY CONTACT: �OWNER� ,�,CONTRACTOR MCI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHOME: �Z� 3Z,"7 �'L('Lt'7 � <br /> n ����,� CONTACT EMAIL: a. �' ���.i yy�� � �e-y•� <br /> AGREEMENT.�T hereby certify that 1 have read and examined this application and know the same to be frue and correct. Al!provisions of laws and ordinances governing this <br /> fype of work will be compiefed whether specified herein or not. The granting of a permif does nof presume fo give authority to violate or cance!the provisions of any other sfate or <br /> local law regulating consfrucfion or the performance of construction. That l am authorized by the owner of this property to pertorm the work for which application is made and l <br /> comply with the State Contracfors Law 98.27 RCW and 296.200 WAC. <br /> Cify of Evereft Official Use Only <br /> FEE <br /> � �C �Cj . � <br /> PERMIT# <br /> -� v � �� 3��� � � �� `��' �� <br /> Owner/Authorized gent Signature Dafe (Revised 90/1?J2095) <br />