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��������� ������ �� ������� <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P)425-257-8890 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettwa.gov/permits <br /> ,. <br /> _ - PROJ�CT SITE lNFORnII�►TIARI _ <br /> PROJECT ADDRESS: � ,- � <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: � . � <br /> - _ ... <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �a-- <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES [�i NO <br /> AS50CIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �CYi �G � '�l�L ' <br /> � r ` ; 3 G�`� . <br /> _ _ . CONTACT INFORMATION . , ,_ <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr � <br /> CI7Y �/ STATE �a^ ZIP g <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: s-rReEr <br /> CIN � � STATE ZIP ,� <br /> CONTRACTOR PHONE: SI cT►�'��o CONTRACTOR EMAIL: M_ <br /> CONTRACTOR LIC.#(REQUIRED): p/�J� � � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER �.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ^ � � g � <br /> a CONTACT EMAIL; - S ��?�� , (V�..1, <br /> AGREEME :T hereby certify that l have read and examined this application and know the same fo be frue and correct. All provisions of/aws and o dinances governing this <br /> fype of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any other state or <br /> local law�egulating construction or the performance of construction. That I am authorized dy the owne�of this property to pertorm the work for which application is made and I <br /> comply with the Sfate Contractors Law 98.27 RCW and 296.20o WAC. <br /> City of Everett Official Use On/y <br /> FEE <br /> � ��� ��� , �� <br /> PERMIT# <br /> .� " " l.��_ �� � 1 lJ�' I�� <br /> �'� � � � � � <br /> wner/Authorized Agent Signature Date (Revised 10/12/2015) <br />