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�����'�I��� ��� �� ��L➢C��'I� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettvfa.gov/permits <br /> ., ,., <br /> , ,_ . . <br /> , , .:. 1tOJE�`� SI`FE 9N9FOI�iViA7'IOId: ` <br /> _:_: . �..,: . �,, . , .. . . : _ . <br /> PROJECT ADDRESS: L�"'/� ,��/.�r <br /> BUILDING AREA(if residenfial,new construction,remodel, or addition) SF ' <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATI'ACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDWG: �, � • <br /> _. . . .': -. , _ , _ ,, .. ,. <br /> . ,. . <br /> .... <br /> '' ECTRICAL APPL.IGATION IINFORMATION <br /> CONTRACT PRICE OF WORK:$ ��� � <br /> NUMBER OF DEVICES(ifi low vo age): ( 2. � S 7 p�'� <br /> FIRE ALARM? ❑YES <br /> ASSOCIATED BUILDING PERM(T#(if applicable): � <br /> DESCRIPTfON OF WORK: <br /> C9�.�R. r s R'��'�`I/V� C3���S S ��� O V 1��1�' � - <br /> i 'c�e -i2x <br /> ; .. . <br /> ... ... . <br /> �. COMTACT INFORMATION .: <br /> , ,. _.:: - : . . . ., . <br /> OWNER NAME: TENANT NAME(If Commercia!): (��� <br /> OWNER MAILING ADDRESS: s-rrzeer <br /> CIIY STATE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �C.- <br /> CONTRACTOR ADDRESS: srReer (�j � �L.,�� � � <br /> cirr CPi� � STATE VVA ziP gD <br /> CONTRAC70R PHONE: �3" S72 ��'+Sg CONTRACTOR EMAIL: Q�.�11, L�� G2 . <br /> CONTRAC70R L[C.#(REQUIRED}: 5��7��..6. �� � v Y CI7Y OF EVERETT BUSINESS LIC.#(REQUIRED): 3�jC7�� <br /> PRIMARY CONTACT;� ❑OWNER CONTRACTOR ❑oTHER(Please Specify) <br /> CONTACT NAME: GONTACT PNOME: -G�5� - 7 2 . <br /> ��� � g l ��i� CONTACTEMAIL: .tj��. Iyta��rver .�,G(.Q,Cr�'�L <br /> AGREEMENT.�T hereby certify that!have read and examined this application and know the same to be true and correct. A!!provisions oflaws and ordinances governing this <br /> fype of work will be compieted whether speci�ed herern or not. The granting of a permit does not presume fo give authority to violate or cancel the provisions of any other state or <br /> locallaw regulating construction or the performance of construction. That t am authorized by the owner of this property to perform fhe work for which application is made and 1 <br /> compiy wifh the Stafe Contractors Lav✓18.27 RCW and 296.200 WAC. <br /> City of Evereit Official Use Only <br /> FEE <br /> ' � � �_ <br /> PERMIT# <br /> � � 9 �� � � �o� - � ��- <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />