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• <br /> ELECTRICAL PE r MIS' APPLICATION <br /> :: CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 ( (E)everetteps@everettwa.gov everettwa.gov( www.everetfwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(If resldentlai,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: TrCOMMERCIAL <br /> USE OP BUILDING: <br /> LEGTRI0AL.APPLIOA"I'ION INFORMATION <br /> CONTRACT PRICE OF WORK:$ }C5p <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? I YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: t 2 C-' E1C I T11_t(n tj G4; c: tisv ,r <br /> laecsx&ri OK.] <br /> • <br /> CONTACT INFORMATION • <br /> OWNER NAME: id (il AAJL 1-4.)6,t--t•vei..,t,�„__ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETI ( r7 (,�� L` <br /> crn, 1?lC.�.{ STATE t.A ZIP I 4g <br /> OWNER PHONE:_ OWNER EMAIL: <br /> s� <br /> CONTRACTOR NAME: l.*:72r fie. 1. C.—Y1 c^ <br /> CONTRACTOR ADDRESS: sTREtir 2.I 2© Cf.-ac-C 7 <br /> CI)"! a/ei '(.�r STATE `J+ A- ZIP r (6-Gi" <br /> CONTRACTOR PHONE ) C ?I f L-1 CONTRACTOR EMAIL: lee d <br /> CONTRACTOR LIC.#(REQUIRED): f ' SOP CITY OF EVERETT BUSINESS LIC.#(REQUIRED --l-Lr? <br /> PRIMARY CONTACT: 0 OWNER If CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: k'f Zg,- 2 2 .� ?/f Lt <br /> Vta..kt I CONTACT EMAIL: .e:t L C� c7J�/� 6e.>Gt.&at <br /> AGREEMENT:1 hereby codify that l have read and examined this application and know the same to be truo and correct. All provisions of laws and ordinances governing this typo <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by tiro owner of this property to perform the work for which application Is made and I <br /> comply with the State Canlractors Law 18.27 ROW and 296.200 WAG. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> c 51-2 <br /> OwnerfAuthorized Agent Signature Date (Revised 9/23/2016) —_ <br />