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��E TR AL PERM T AP�ICATI N <br /> C IC I O <br /> CITY 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: _ - � '����� � � '' � � .f� ' ' / j ;'i�� ; <br /> BUILDING AREA(if residential,new construction,remod ,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: :l�� l / � �_�_- ''� ,%"�� ,$� A:-�-' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � ' ��' � � . ( �: , <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION O WORK: 't�-j� �. � . � � I �.= � � — <br /> ''� :. ����-=�� `� �-/ � � �''�� /(` �- ` <br /> � <br /> �' ''/� � �� ` �.� . � J�I <br /> CONTACT 1NFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): � •� � j, i�' /:��¢' � ' ' �"` <br /> OWNER MAILING ADDRESS: sTReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � � � '�� <br /> ��. ,� .. S C., '� � <br /> CONTRACTOR ADDRESS: srReeT .) -- �� — i � <br /> � <br /> fTY L �. STATE ZIP � �� � <br /> CONTRACTOR PHONE:I_-d`��� , , CONTRACTOR EMAIL: �' ����)� �'�� � � ��'- � �'',%7 - f��-'�L J <br /> G�� � �� J" �. r � <br /> - �; <br /> CONTRACTOR LIC.#(REQUIRED): � (�. � � l e.'.�� ,�'�_�/�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � `�� ���) '/' <br /> PRIMARY CONTACT: ❑OWNER � NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � � d `�' � <br /> ���.�����I.-�°� �_-,������� �`.� ��� CONTACT EMAIL: � ��� � :� -.� � � ; -_ __� r ��.. ; ,� <br /> . � � 1� � -Y � <br /> AGREEMENT:I hereby certify that 1 ve read and examined this application and know the same to be true aritl c rrect. All provisions of/aws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a pe�mrt does not presume to give authority to violate or cancel the piovisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to per/orm the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ��--� � - ,,� , ��;�� E �� ���- -�G <br /> er/Authorized Agent Signature Date (Revised 9/23/2016) <br />