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��c���c�� ���r�i� �� .ic��»� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W�9820 i <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� wvvw.everett�va.gov/permits <br /> PROJECT SITE INFARMATION <br /> PROJECTADDRESS: � 5�(7 (�2, 'c���CT � �., h ��,—�{-(- �,,� <br /> BUILDING AREA(ii residential, nelv cc^struc'tion: remodei, or addiiion) SF <br /> BUILDlNG TYPE: ❑ SFR-DETACHED ❑5FR-ATi'ACHED ❑ DUPLEX ❑ MULTI-FAMILY-�OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ - �`' <br /> Zo�-`� . - <br /> NUMBER OF DEVICES (if lov�volta e): <br /> F1RE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERM(T#(if applicable): <br /> DESCR►PTION OF WORK: c��F� I�;' ����+ ���� <br /> ��� � ('c7 c —,,. : <br /> � , l� � 1�b�- � � <br /> CONTACT INFORMATION <br /> OWNER NAME: ��'�v:c��C��.vtiL� � ';��' v' �_;� TENANT NAME(!f Commercial}: <br /> OWNER MAILING ADDRESS: s-rReer <br /> a�v sra.r <br /> Z�p <br /> OWNER PHONE: OWNER EMAfL: <br /> . <br /> _ <br /> CONTRACTOR NAME: ���:.� �(���L <br /> CONTRACTOR ADDRESS: s�e� ��(„') �� ;U�� � <br /> CIT! ��'(,�.��tr. 3TATE GNrT Z!P �C�C��j <br /> CONTRACTOR PHONE: Z#,L -4�(.s�• �7.GC CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#E(REQUIRED) L'CC.+'��C_,l��{'Z 1tti'L„i CITY OF EVERETT BUSlNESS LIC.#(REQUIRED):C���F4 S <br /> _ __.. _.... __.. .,, ,...... <br /> _..-- _:. <br /> . ........ ....._.... _.::, _.. <br /> PRIMARY CONTACT: ❑OWNER � � ` �� <br /> .�..,. . ........ _ ......_.,_...._.._ <br /> CONTRACTOR �OTHER;Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Zu�_ • <br /> � j �'� � �.`5�3„�:'�_, <br /> ���'� `���`i..�'tvx.[� CONTACT EMAIL: �` J � <br /> ���t�,'��v ....7G=!'f i:�J c.c.s��L;,� �`� (.''�F"F.C�C t�l <br /> AGRcENE�'JT. T f,eraby csrtifij tha!1 have read and examined�nis ap,olicaiion ard P.r,ow tF,e samF to oe true and correcf. P.II erovrs.�ens ofla�ris�rd ordir,2nces gonmino i"r,is <br /> fype o`wor,k�:�iil be compiered v.�eth.ers�ecir7eo her2in or no<'. The graniing of a permi;dces not presume to give authonty to i`o/ate or cancel ine provisions of any ofr,erst=.e or <br /> locailaia�regu/ating consta;cticn or the performance of construc';bn. That l am authcr;zed by tne o!vner oi fhis propary fo Ger,`crm th,e wor'r,,or r�i•,rch application rs�Tade and 1 <br /> comp;y tvith the St2[e Corfr�iors Lav.�18.27 RCNar,d 2382C0 I�JAC. <br /> City of Everett Gi�;cial Use Only <br /> FEE <br /> � � � � ��, <br /> � <br /> f''f ^l PERMIT# <br /> . _ ,.-� ��= � �¢; " � ;.� ;� E � � -� l D'�� <br /> Own�er/Authorize AgentSignafure Da� <br /> �/ (Revised i0/92/2015j <br />