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�i�Ec-rRicA� ��Rnns�r A�Lic�riorv <br /> C1TY 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 /> _ w � : <br /> _. - ., , <br /> , <br /> ' ' PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: � �y <br /> BUILDING AREA(if residential,new construction,remodel,or addition), � SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILD[NG: <br /> . . -�:_ � , o. . <br /> �:.. , ., :, <br /> . s .. <br /> ` ELECTRICAL APPLICATION INFORMATION; ,: <br /> CONTRACT PRICE OF WORK:$ ,��C��<�� � <br /> NUMBER OF DEVICES(if low voltage):� <br /> FIRE ALARM? ❑YES Uie NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION.•OF WORK: .� f�� � n � Q <br /> .. _ _ <br /> � _ CONTACT INFORMATiON _. - : <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-raEEr �� <br /> CffY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> .,. . ... . .. . ... , _.... ,. ., .... . . .. . .. ... .. ... . . <br /> . ... .. . . . .. . . .. . .. . . .. . .. . . . ... <br /> CONTRACTOR NAME: � �,J„C. <br /> CONTRACTOR ADDRESS: sTReer ����� �� �'� <br /> cin -�...�~ f'c !�.. sra-re ��is�,r'�. ziP ��� <br /> CONTRACTOR PHONE: �����i�ja ��j L� CONTRACTOR EMAIL: ,r--� ' <br /> CONTRACTOR LIC,#(REQUIRED):�`. �� � � . CITY OF EVERETT BUSINESS LIC.#(REQUIRED):���"'S� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L �'��('J<.-���� � <br /> ��� ��Jci' CONTACT EMAIL; <br /> AGREEMENT.•T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of(aws and ordinances governing this <br /> type of work will be complefed whefher specified herein or not. The granting of a permit does not presume to give aufhority to violate or cancei the provisions of any other state or <br /> local law regulaSng construction or fhe performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 29E 20o WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> � �sa �� <br /> �,,..,._ PERMIT# <br /> �.. <br /> - � ���-����� E r��a - a�5 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2095) <br />