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'������'��� ���. �� � �������� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98209 <br /> (P}425-257-8810 � FAX 425-257-8857 j (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> _ _ _ <br /> , . _ .. <br /> __ <br /> . <br /> - ' PRO.)E�'1" St'TE INFORfWA7'IOId': <br /> PROJECT ADAi2ESS: 2�s V ��2., [ � <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 /> e ,� r _- ^ <br /> USE OF BUILD(NG: Pf�-yy,,,� <br /> � : ,,, .. .._: --_. <br /> , ... <br /> - <br /> ELEC'CRIGAL APPLICATION INFORMATIAN. . <br /> .. _ . . .. _ _ _ o . .. . . .. <br /> CONTRACT PRICE OF WORK:$ I�r � � <br /> NUMBER OF DEVICES ifi low voltage):� <br /> FIRE Al..ARM? YES ❑NO <br /> ASSOCIATED BUILDIIVG PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � �t�- �"�y <br /> -. .,. : . , ,. .. . - <br /> . .. . <br /> CONTACT�INFORMATION. <br /> OWNER NAME: d, TENANT NAME(If Commercial): <br /> OWNER MAILING AQDRESS: 1 j �r ��.li/ � �� <br /> CITY L��L�( STATE ZIP g ����� <br /> OWNER PHONE: — S S6 ��"' OWNER EMAIL: /�-E'_ <br /> CONTRACTO:R NAME: (il�N�I�, <br /> CONTRACTOR ADDRESS: srReer � <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ' <br /> CONTRACTOR LfC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT:��OWNER L rcCl CONTRACTOR ❑OTHER(Please Specify} <br /> CONTACT NAME: CONTACT PHONE: � <br /> a CONTACT EMAIL; <br /> AGREEMENT.�T hereby cerfify that l have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances goveming this <br /> type of work will be completed whether specified herein or not. The granting of a permif does not presume fo give authority to violate or cance/the provisions of any other state or <br /> Iocal law regulaSng const�uction or the performance of construction. That!am aufhorized by the owner of this property to perform fhe work for which application is made and 1 <br /> comply with the Stafe Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Onty <br /> FEE <br /> ��C�•!�O <br /> PERMIT# <br /> ���;,�� Q , r��- � - ) �- 1 � E � go3 '0 SS <br /> OwnedAuthorized Agent Signature Date (Revised 10/92/2015) <br />