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�ECTR�CAL PER�`�T AP�LICAT[ON -
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 32�0 CEqAR STREET, EVERETT, WA 98201
<br /> (P}425-257-8810 ( FAX 425-257-8857 � (Ej everekteps@everet�arwra.gov � w4vw.evereftwa.gov,'permits
<br /> PRCJECT$ITE INF'ORMATION _ _
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<br /> P'F��JEC7 ADDRESS: � ' �,�, '
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<br /> �WlDtNG AREA(if residentiai,r�ew construction,remode4,or addifion3 '��
<br /> �UlIDiNG TYPE: ❑SFR-DETACHED ❑ SFR-ATTACNED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNIT$ ❑CONEMERCIAL
<br /> t�SE OF BUILDING: _ _
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<br /> ' CONTRACT PRiCE OF WORK: � ; ` :�..r n 0 `
<br /> N.UMBER OF DEVICES �f low...vol#�t e !.;: . .
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<br /> FiRE ALARMT ❑Y�S C]NO
<br /> �l5�t3Cl,i�TED BU[L.DING PERMIT#-if� :(.icabla°;
<br /> DESCRIPTION OF WORK: . ; �ZO�/ C�.2� �t'�. ';: ,1U ` �Y1S : G�
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<br /> C�`fl�C�l�NAME. " _ TENANT hIAME ��C�st��r�a�!x
<br /> t3Ul��I�Et MAILWG;ADDl�E�. : s�xEET '. , ,' , �,- '
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<br /> OWN�R PHON�E. �1 c�� � [3 �"�r�S 'OWNER EMAIL:
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<br /> CONTRACTOR NAME:
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<br /> CONTRACTOR ADDRESS: _srRE�r , �'' ,` "" ";
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<br /> CRY STATE ZfP '
<br /> CONTRACTOR PHONE: � � �!�`�6�"F't�.�:EMAILt ' � � �I�'}
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<br /> CONTRACTOR LlC.#�k�Ef��lt���; ; , � �, +�:17Y QF EVERETT�t��IN�S3 L,IC.- 1��#�i�[��t��a � ` °
<br /> PRIMARY CONTACY: ❑OWNER
<br /> G�JNT�G�`C�� ❑OTHER(Please Specify)
<br /> CONTACT NAME:_� . CONTACT PHONE: • '
<br /> 'CONTACT EMAII: ��t,,�
<br /> AGREEMENT.�T hereby certify fhaf t have read and examined fhis appiicatian and know the same to be frue and conect. Al!provisions oflaws and a. �govemrng this
<br /> rype of work wil!be compfeted whether specified herein or not. The graniing of a permit does not presume to give authorlty to vioiate or cancel the provisians of any other state or
<br /> focaJ law regulattng constnrctfan a the performance of canstrucrion. Thaf 1 am authodzed by fhe owner oi this property!o perfom+the work for which apptication is made and�
<br /> � , �►�i�ia S#�t���s�tl�c�at`�L�i��t�GirY;Br�d..�@�.Z�! .�. �____• __.�.___...___
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<br /> C�ty of Everett O�craf Use Only
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<br /> - , , PERMIT# ,
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<br /> � � :� � -. � 3 �- E ��Z -- 0 Z�
<br /> Owner/Authorized Agent Signature Date (Revrsed f0/1212G�5)
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