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IEL��T I�.A� �� 1T A 1C TlOhl <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425-257-8810 � FAX 425-257-88�7 � (E)everetteps@everettv+ra.gov] www.everettwa.gov/permits <br /> . . ;,. ..... .� .__ _ _ <br /> ,. _ _ .. . <br /> -. ' PROJECT SITE 1NFORMATIAN:`. <br /> ,, <br /> _... . . ... .._ _... _... <br /> ,. . . ., ...: . ..;_ _. _. _ ..... . . <br /> PR�JECTADDRESS: � c�E .-�f � �-�- J� �j <br /> BUIL�ING AREA(if residenfial,new construction, remodel,or addition) SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: • <br /> „ -... ;, -,. . __, • <br /> ,. . <br /> LEC RICAL APPLICATION INFARMATION ' <br /> CONTRACT PRICE OF WORK:$ � <br /> NUMBER OF DEVICES(ifi low volta e):� <br /> F1RE ALARM? YES ❑NO <br /> ASS�CIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � S 1 <br /> ; . � ... .. .. . . ... . .. . . . _ <br /> ..� _ . . .. - . <br /> � _ _ � CONTACT�_INFORMATION_. _ - <br /> . _ , .. .. .: ..... ._ <br /> OWNER NAME: h TENANT NAME(if Commercial): � 1� <br /> OWNER MAILING ADDRESS: srReer � <br /> CITY j�v � STATE �� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME: �r ) v' � <br /> CONTRACTORADDRESS: s-ixe�- � � — V `e ^ <br /> CffY ,� STATE v v /�' ZIP <br /> CONTRACTOR PHONE: Z , CONTRACTOR EMAIL: l � (� <br /> CONTRACTOR LIC.#(REQUIRED): S� �C�� CITY OF EVERET7 BUSINESS LIC.#(REQUIRED. �J �� <br /> PR[MARY CONTAC?: ❑OWNER 4Y�CONTRACTOR LCI OTHER(P(ease Specify) <br /> CONTACT NAIVIE: CONTACT PHONE: Z.-{�� �� • <br /> � �1�. C',�;�'')��`�� CONTACT EMAIL: � 6{-�S� _ <br /> AGREEMENT.�T herehy certify that!haue read and examined this applica6on and know the same to be true and rrect Al!provisions oflaws and ordinances governing this <br /> type of work will be completed whether specified herein o�not. The grantfng of a permif does not presume to give authority fo violate or cancel the provisions of any other state or <br /> locai law regulating consfruction or the performance of construction. Thaf i am authorized by the ownerof this property to perform the work for which application is made and l <br /> comply with the State Contractors Latv 98.27 RCYI/and 296 200 WAC <br /> City of Everett Official Use Only <br /> FEE <br /> so — <br /> PERMIT# <br /> z- �' <br /> � � �- C ( � l� �j <br /> Owne/Aufhorize nt Si�natu Dafe (Revised 90/12/2095) <br />