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������'��� �� �� � ������ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-88'10 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettvya.govlpermits <br /> .. <br /> _�, ; . .. <br /> , _ _._ <br /> . <br /> � � - PROJE�T S17'E IMIFORMA7°'tON. <br /> .. . _.. .. .. _ .. <br /> _... _ . . <br /> PROJECTADDRESS: � �jj� ��J c� ��, <br /> BUILDING AREA(if residenfial,new construction, remodel,or addition) ��� SF � <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR AT("ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: Q��� <br /> .. ---. . <br /> .. <br /> ' ` ELECTRICAL APi�LICATION INFORMATION <br /> CONTRA,CT PR10E OF WORK:$ �Q � <br /> NUMBER OF DEVICES(ifi low voltage):� <br /> F1RE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDIIVG PERMIT#(if applicable): <br /> DESCRIPTf�N OF WORK: � ��- �ew�e$(`.P.et'I� i �,'�' 1.�1 r��-'S, �`� <br /> r�' -fr'.�e �lwr� c� c a v2 t a� ��- - <br /> ,� v� �fi�2 ad <br /> ��r � ��, �v �� <br /> ; .. _ _ <br /> , ��n�wcc{�0�. . . . . ..:.:. : CONTACT;�INFORMATION : _ <br /> OWNER NAME: � �(iV1 TENANT NAME(If Commercial): <br /> OWIVER MAILING ADDRESS: s�eEr �L I ��`' ��. <br /> CITY ���, STATE ZIP �� <br /> OWNER PHONE: •��/ i� �� OWNER EMAIL: '�1n1�OvlS{YU��v►i,�,rq, (�d�.G+.Q , �� <br /> CONTRACTOR NAME: lL l�t� <br /> CONTRACTOR ADDRESS: s-rRe�r �` ^ <br /> arv �IN7,� � sra� zia � <br /> CONTRACTOR PHONE: i/ 3 � `t 7 CONTRACTOR EMAIL: R,1�(� S2t,^+C� Cli�(�v�'C. !✓14.�(r C5 <br /> CONTRACTOR LIC.#{REQUIRED): �j C'j C1TY OF EVERETT BUSINESS LIC.#(REQUIRED):���' <br /> PRIMARY CONTAC7: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `,t, (�� � <br /> • ���J :� CONTACT EMAIL; �� �,� � �-r� � ' � <br /> AGREEMENT.�T hereby cerfify that(have read and examined this application and know the same to Be true and correct Al1 provisions of laws and ordinances governing this <br /> type of work will be compieted whether specified herein or not The granting of a permif does not presume to give authority to violate or cance!the provisions of any other state or <br /> loca!law regulafing construction or the performance of construction, That!am authorized by the ownerof this property to perform the work for which application is made and! <br /> comply with the Sfate Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Evereit Official Use Only <br /> FEE <br /> � ,�Z�,,�� <br /> �"� . _ i���o��a(�� <br /> � � � <br /> OwnerlAuthorized Agent Signature Date (Revrsed 10/92/2095) <br />