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EL�'TRICAL PERMIT APPI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��,L'y \,,�' � � �• t � � `� '� , <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: � y �., —�- L- � ,-.� '=� � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �� �*L , ` �� <br /> NUMBER OF DEVICES (if low volta e : � <br /> FIRE ALARM? ❑YES �1 NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: '\ � � � `�-y • - Y <br /> CONTACT INFORMATION <br /> OWNER NAME: � � _� � � "•� , - - TENANT NAME(If Commercial� � _ 1� <br /> OWNER MAILING ADDRESS: s�aeeT Z �� � � �� ( � �,. r`.� <br /> TR <br /> CITY �- I / STATE _ ZIP� %�.�jL� <br /> OWNER PHONE: - �-Z ,�j� OWNER EMAIL: <br /> CONTRACTOR NAME: `� � • �- - �� ` �--� '^n <br /> CONTRACTOR ADDRESS: sTReeT � . '�i ) < = - � , s;,�� � <br /> cirv �, ' i.�` "� STATE ziP <br /> CONTRACTOR PHONE: L� - � �°.j�-�'� Z Z CONTRACTOR EMAIL: �, a • -•.,r}, - ,�,t„� <br /> CONTRACTOR LIC.#(REQUIRED):�.,� ' -y ,y L, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �j ��` <br /> PRIMARY CONTACT: ❑ OWNER `�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:!�1�_ � � ._� L� <br /> � ��. -_ ., . CONTACT EMAIL:r�� ,/J � �.� � '� -�'�' , ,; c_a.X - <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this (�y;�� <br /> fype 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 const�uction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application 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 /> ��j�, `�� <br /> PERMIT# <br /> � E �� o� - � I � <br /> , <br /> . �,R �1.�,.._ ��1► - ►i <br /> Owner/Authorized A en ignature � Date (Revised 10/12/2015) <br />