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4Err CTRICAL PERMIT APOPICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: j (-1 )( y Cs sr-- e_v l t ! l , u,A • <br /> BUILDING AREA(if residential, new construction, remodel, or addition) g 6 MOP C L SF ( 3 GI C <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: I tlf(» 1 45 PM 6 , 5/ ()G IV 1 1/�L <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): IL)0 O i&, V(7l !l G G <br /> FIRE ALARM? El YES GEL NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ( IAI 15" O L 66 <br /> DESCRIPTION OF WORK: �( }' G / c!>//) L� �' /;r +-r ``�L u�'�L L�co°Mrs) <br /> I. 1 f t E };1 ( 11ZC- N ouc <br /> CONTACT INFORMATION <br /> OWNER NAME: t j N/4 ,r- pcp T) 6%ZL op J.LC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (Q gfi 136 L L Fie-LA PAR le. „I...1)1V a <br /> CITY J 3 L L,L L' it/ C STATE 1040. ZIP clzc <br /> OWNER PHONE: !5 - LiN2 " 3 7 S f OWNER EMAIL: <br /> CONTRACTOR NAME: PG" tv t(L I L c'rR C <br /> CONTRACTOR ADDRESS: STREET t7 U f 0 \ki V I.J R <br /> CITY EVE/lt'rT STATE UV/'" ZIP (I'" 26 3 <br /> CONTRACTOR PHONE: C,G((� (S?,/ - 9 I :2j CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): PC)(,.1/(- /Z t•• c q ( Y c. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3 C� '/2 <br /> PRIMARY CONTACT: jai.OWNER El CONTRACTOR Cl OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <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 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 /> PERMIT# <br /> VeC/ s' E I D -? - /50 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />