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Feb 28 17 09:33p p.1 <br /> � � <br /> E�ECTRICAL PERMIT APPLICATION <br /> � <br /> GITY OF EVERETT PERMIT SERVICES '1,�1�� ' <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 ' <br /> (P)425-257-8810 ] FAX 425-257-8857 � (E) everet#eps@everettwa.gov� �wvw_everettwa.gov/permits <br /> PROJEC7' SITE INFORMAT[ON <br /> PROJECT ADDRESS: -.�v'• � �r' •�✓,�� .-L':� .��- / `���...��G�'�GL� �;��J 7 <br /> BLIItDING AREA(if residentiaf,new construction,remodel,or addiiion) ��.L`�L<�'-L SF '� <br /> SCiILDING TYPE: � SFR-DETACHED ❑ SFR ATTACHED ❑DUPLEX MUI.TI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING_ .�;:,�!__�.y�.�'�'�-�i <br /> ELECTRICAL APPLICATION IN�ORMATION <br /> CONTRACT PRICE OF WORK: � � �i�-"=- <br /> NUMBER OF DEVICES if low volta e : � <br /> FIRE ALARM? 0 YES T10 <br /> ASS�CIATED BUILDING PERMIT# if a licable : �� `� � � <br /> DESGRIPTiON OF ORK• %�,/�, ' `.,�2 ' :.-� Yti v..� d?-�„/-/�y"�:��= C-G- Z�',,�.�'�'�'� <br /> �� ���ri��'v '-� �...� 1��z�� ��= ��'z � %�'z.N�::%?��� G�.�v..��?-- <br /> .� l .��/1(iv✓ � Y / � <br /> CONTACT INFORMATi�N - _ <br /> OWKER NAME �"�?� ,?�:Yr����: ' - L�. ;� �— �-'�TENANT NAME If CorrEmercial : <br /> OWNER MAILING ADDRESS: s ` er _ �L�G% Gj��//% ��'--,G'i ./7 �� ' �� � c�C'�. ��� <br /> . <br /> � e �'�r ��7Y STA7E ZIP'� ,�,�C. — <br /> C " <br /> OWNER PHONE: OWNER EMAII.: �G% <br /> � /,"�, % <br /> CONTRAGTOR NAME: '`,� �._,(�"�z�.������- <br /> CONTRACTORADDRESS: srrzeer � .� -1'�iZ.Cc�!'s �c:-• - G��'��G��1 f.1G-`•�,✓�J� <br /> ..�� ' <br /> ,��I�'.�,�/� '�'✓ crrv � G� <br /> ' G G� STATE nP .J�,,� <br /> � �� 7 � � T�'�" ' ,� �1_.. /37�/ <br /> GONTRACTOR PHONE:� '� --�J� � i . CON7RACTOR EMAIL: .. G /�� -i�,'7 t� � � � <br /> / r <br /> CONTRACTOR LIC_#(REQUIRED): — ,�� � CITY OF EVERETf SUSINESS LIC.#(R[QUIRED):�Ir:.o ����/( <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER{Please 5pec'rfy) `��, <br /> CONTACTNAME: COI�f7ACT PHONE: �L�� = � �3�/7/�7, �%k�, � <br /> j / C`��L '' <br /> �-�/�'� / LC-/�? . �-���� j CO[�TACT EMAIL: <br /> AGREEMENT:I hemby cerlify that/have iead and examined this app�cation and'know the same to be fiue and coirect. AU prpvlsiors of luws and ordrnances�•�^•�ernmg fhrs type <br /> 07 work wrlf De comyleted whether specified herein or noL The graniing ofa pertrrit does not presurne fogWe authoriry to violate orcance!ihe prov�siorrs of ai her state or <br /> /ocal faw regulating corrslrucL'on or the peri`ormance of constiuction. That l am authorrzed by rhe ot�mar of this property to perfqrm the urork for which application is made and 1 <br /> cornply wifh fhe State Coniractors Law T8.27RCW and 296.200 WAC. _ � <br /> ���/� /� �, ���. o <br /> [j��C�- �' ��i;�✓ �'7 � j�-.`ri� �� � �-l� f/'.�%C�C �� <br /> . <br /> City of Everett O�cla/Uso Only <br /> PERMIT# <br /> � , y� <br /> /y ' �/^ / % 1�-'�' � >�:�y`�� �1� V D� <br /> OwnedAuthorized dge►rt 5ignafur Date <br /> (Revised 9123/2016) <br />