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���������� ��� N� � ������ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'1 <br /> (P)425-257-8810 � FAX 425-257-8857 j (E) everetteps@everetiwa.gov� www.everettwa.gov/permits <br /> .. _, . ._ : ,.. , .. _ <br /> ,. _.. <br /> .. _ <br /> , o,����- so°r� 'r��o�a���-ra►�v . <br /> . ._ . <br /> �� - : <br /> PRQJECT ADDF2ESS: � ' �, V'e. <br /> BUILDING AREA(if residential,new construction, remodel,or addition) '�'�AoG�G SF � <br /> BUILDING TYPE; ❑SFR-DETACHED SFR-ATfACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILD[NG: ` ��,nk� • <br /> .... ,.: ,.. _., : <br /> . . <br /> ELECTRiCAL APPLICA7"lAN INFORMATION <br /> CONTRACT PRICE OF WORK:$ Q(�,�� � <br /> NUMBER OF DEVICES(ifi low voltage):• <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> � DESCRIPT(ON OF WORK: � 'r �Z. �G��no `' ��� <br /> ���('Gtii� 'M�C°c' G.S`Lu`�' a. t'� . <br /> , . ., .. , . . . _... <br /> .. _ <br /> ` , .:CONTACT;INFORMATION. . - <br /> OWNER NAME: �(`o� ��(' � TENANT NAME pf Commercial): <br /> OWNER MAILItVG ADDRESS: s-rReer <br /> CITY STATE ZIP <br /> OWNER PHONE: `���� �J�I(�� � 3� OWNER EMAIL: <br /> CONTRACTOR NAME: � � 1' � <br /> CONTRACTORADDRESS: s-rRe�r �Z�Z ��'t=� L, W <br /> CIN � � C�O STATE "� ZI� q <br /> CONTRACTOR PHONE: Z ��O � CONTRACTOR EMAIL: ' <br /> CONTRACTOR L[C.#{REQUIRED): O Z, 'J� '�(� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (''l� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify} <br /> CONTACT NAME: CONTAGT PHONE: � <br /> Q CONTACT EMAIL: <br /> AGREEMEhfT.�T hereby certify that l have read and examined this application and know the same to be true and correct. AI!provisions of/aws and ordinances governing this <br /> fype of work wrll be crompleted whether specified herein or not. The granting of a permit does nof presume to give aufhority to violate or cance!the provisions of any other state or <br /> local law regulating construcfion or the performance of construction. That!am aUthorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Latv 98.27 RCW an.d 296.200 WAC <br /> City of Everett Official Use Only <br /> FEE � <br /> . � � �a °---� <br /> a <br /> PERMIT# <br /> � �`z \�l E ' ��j� 'b�� <br /> 0 ner/Aufhorized Agent Signature Date (Revised 90/92/2015) <br />