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<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� v�niwv.everettwa.gov/permits
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<br /> : PROaIEC'f' S1�'E INFORf1f1i47'IOId ` '
<br /> PROJECT ADDRESS: �/ (, � n�.,,Q L�n.--{�- U�j�,i —
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED I�1�DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: �(�� , �� -•
<br /> ELECTRIGAL APPL.ICAYION INF�RMATION
<br /> CONTRACT PRICE OF WORK: $ � �' ''�'
<br /> NUMBER OF DEVICES (ifi low voltage):
<br /> F1RE ALARM? ❑YES �1 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: C� /i!'� " l {^/� L�I� G I `� � �IC'I L` i- ,,n
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<br /> ' ; CONTACT INFORMATION `
<br /> OWNER NAME: l�G,� � �i�I �,r TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sraeEr
<br /> CITY STATE ZIP
<br /> OWNER PHONE: �7i� 7`I �(�C� OWNER EMAIL:
<br /> ... . _.. . . .. ... :. ...... .. .. ..., . _, ,. ... . . ..._..
<br /> . _. . ... . . .. . ...
<br /> CONTRACTOR NAME: /C����,-� �L�t�t�.,G C7 �!^,S"�+'l / �' '
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<br /> CONTRACTOR ADDRESS: sTReEr .�l L � J
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<br /> CITY G(�' J � STATE U�jCI ZIP ( � ��
<br /> CONTRACTOR PHONE: �2 y oZ`� -<3 S`I CONTRACTOR EMAIL: /
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<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF'EVERE7T BUSINESS LIG#(REQUI ED): � I
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<br /> _..,. _ � �
<br /> PRIMARY CONTACT: ❑OWNER [�CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �` ` �j _�3�� � �
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<br /> ✓' G/n � C%G��� CONTACT EMAIL: C�v-1 G�'? , "� C''�' [���� � i G . <�t:�
<br /> AGREEMENT.�T hereby certi{y that I have read and examined this application and know the same to be true and correct. A/l provisions oflaws and ordinances governing this
<br /> type of work willbe completed whether speciFed herein or not. The g�anting of a permit does not presume to give authority to vro/afe or cancel the provisions of any otherstate or
<br /> local law regu/ating construction or the performance of consfruction. That/am authorized by the owner of this properfy to perform the work for which application is made and/
<br /> comply with the State Contracfors Law 78.27 RCW and 296.200 WqC.
<br /> Cify of Everett Official Use Only
<br /> FEE
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<br /> PERMIT#
<br /> , �-� � �-� ���-� � �� 3 � �� '�
<br /> Owner/Authorized A ent Signatu Date (Revised 10/12/2095)
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