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������ic�� ���nni�r ��_ ���ic��iotv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 95201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> � <br /> PROJECT ADDRESS: ����- ���� �j'/L- � (��L=�L-- . �/ G✓ ��f vG ij I- <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: ��S I'(J` �. � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ .�J� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES �' 1�0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> Y'��� �~' �j/�'�� � �'�`- i i � �S/"!J�_� ����',j'�'t-//�J�c� , <br /> �<���v <br /> CONTACT INFORMATION <br /> OWNER NAME: �'L�hl'� �L �L���(.i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer ��L�Z ' �- y �/' <br /> CITY ����L- /! STATE � ZIP nnC/ / <br /> OWNER PHONE: �Z �v%���,�`�� OWNER EMAIL: <br /> _ . _ <br /> CONTRACTOR NAME: L� .l - r'L � �L��1;�- �-- G l�G <br /> CONTRACTOR ADDRESS: sraee-r /�S`~c,i� .3�� f L- : �v � <br /> CIiY Y � /Y(./(��C./ STATE �� ZIP ,�U��'� <br /> CONTRACTOR PHONE: � jJ�'„j� ��j � CONTRACTOR EMAIL: �S�'/��f1!� 1-- l�'k.z � cy`?���i � ^ �L <br /> CONTRACTOR LIC.#(REc1UIRED): C l i�-C�L`Z-�',�`,y v S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C����C�- <br /> -_..� . .___..- : . . .. ....... :. ........ ..�._.,.:.:..,. .... ...... . _.__ ,..:.., . ._.:,.,_ . _ ...:.. . - <br /> . ,.._. _ _..._.. _,. .._ <br /> PRIMARY CONTACT: ❑OWNER I��GONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � <br /> �,P� G��3� CONTACT EMAIL: <br /> AGREEMElVT.�T hereby certify 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 will be comp/eted whether specified herein or not. The granfing of a permit does not presume fo give authority to violate or cancel the provisions of any other stafe or <br /> local law regu/ating construcfion or the performance of construction. That l am authorized by the owner of this property to pertorm the work for which app/ication 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 /> FEE <br /> i� _� I,— - (��, <br /> �� PERMIT# <br /> ,' ; .i�--, _ ��-�� E 1/�C ��l,D l- 0� <br /> Owner/Auth z A tS' a yte Date (Revised 10/12/2015) <br /> / <br />