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��EC`�R1��4� ��RN11T AP E _ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORM�►TION <br /> PROJECT ADDRESS: �� . L'� ���, �Li�� �9 ��� f��G'' ��� � /� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: �R-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: �� " ��C[_� !( �� �. � <br /> CTRICAL APP ICATION INFORMATION <br /> CONTRACT PRICE OF WORK: - �� <br /> NUMBER OF DEVICES (if low oltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT i applicable): <br /> �ESCRIPTION OF WORK: <br /> ��� �-��` -� ��� ��2(- {�G'" �.df-�- t=�/ � 6-tr'�s��j����i � <br /> �:�'' `�/t 'r l�`2- ��� �-<=-`2 <br /> CONTACT INFORMATION <br /> OWNER NAME: /�� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr <br /> CITY STATE ZIP <br /> OWNER PHONE: �� ��� � � E" ` � OWNER EMAIL: . � �� ' � �j-} �; C- 1��,� i (t"« <br /> ._ . /. _ <br /> CONTRACTOR NAME: f / . `\ � , , i c�� � _I<'--- L_ �--d''f C <br /> CONTRACTOR ADDRESS: sTREEr ,G�"�/ . � ` � % q 6 '{G( �l'� <br /> � <br /> ..�.� '7f� � �F CITI' STATE � ZIP ��? C, <br /> CONTRACTOR PHONE: - j 3 L/ CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): �,�: ' t r l j= J � ;,�,� CITY OF EVERETT BUSWESS LIC.#(RE UIR / <br /> PRIMARY CONTACT: ❑OWNER �RACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: , � "� �',-�'� � � <br /> ��E'l1{-1 � `.—I�L"-� CONTACT EMAIL: � ,�f '' (� � �; C.I'—/y�'i�I i�f�� <br /> AGREEMENT. T hereby cerfify that I have read and examined this application and know the same to be frue and correct All provisio,�s of laws and ordrnances governing this <br /> type of work will be completed whether specified herein or nof. The g�anting of a permif does not presume to give auEhority to violate or cancel the provisions of any other state or <br /> loca/law regulating construcfion or the performance of construction. Thaf/am aufhorized by the owner of this property to pertorm the work for which app/icafion is made and/ <br /> comply wifh the Sfate Contracfors Law 18.27 RCW and 296.200 WlIC. <br /> City of Everett Otficial Use Only <br /> FEE <br /> i� LJ T -_� <br /> PERMIT# <br /> ���� ��� 1 -��7 -� E � �� � r �-- C� <br /> �--�= <br /> Owner/ uthorizedAgentSign ure Date (Revised10/12/2015) <br />