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�ELECTRICA� P�RtUIIT �PLlCA`�I�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-25�-8857 � (E) everetteps@everetfwa.gov � www.evereitwa.gov/permiis <br /> PROJECT SITE IN�ORMAi'lAN <br /> PROJECTADDRESS: J,�2.1 ��` (�jv ��� <br /> BUILDfNG AREA(it residential, new construciion, remodel, or addition} SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: � COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATIQN INFORIVlATION <br /> CONTRACT PRICE OF WORK: $ �(�:j�.`'A= <br /> NUMBER OF DEVtCES (if Iow volta e): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERM[T# (if appiicable): <br /> DESCRIPTION OF WORK: '� <br /> �.� , �% r-��� ���-�,�, �.-<< � A(���� i t �� <br /> �� � � z�c�;.��t� � � ;� 3 �«t-[c � <br /> 't^'1 �l` �c.;�� �.1f `7�rtitL.n Fi Ca Ci���,•� �� Ov�• �j � <br /> CONTACT INFORMATION <br /> OWNER NAME: ��'0 u,�:ti�,n t.4 �}Cy,�w l �Jr TENANT NAME{If Commerciai): <br /> OWNER MAILING ADDRESS: sr�e�r <br /> crrv <br /> STP.TE �❑ <br /> OWNER PHONE: OWNER EMAIL: <br /> _ <br /> _ <br /> _. . ... _ <br /> CONTRACTOR NAME: �� �(��^t L <br /> CONTRACTOR ADDRESS: S�aE�r '�(� "U:,,,��, � <br /> c�n ..Z[�:�i.� Gti�' <br /> s�nre zi� ��lb�. <br /> CONTRACTOR PHONE: Zt�; -�f?,{;,.• j�,;G CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#�(REQUIRED) � eC:.��tC,,.i��'Z i�'� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C'�c:U�F4� <br /> __._.. .._._ _ _.�.. .,, <br /> _...._. __._.. _,.,. <br /> _ .._... . _.__._.. ....,.:. <br /> _..:_ <br /> ._,._._.�..... ....... ._._..�..__ <br /> ARY CONTACT: ❑OWNER __:....... ._....._...,:.._.._ <br /> Y�CONTRACTOR C�OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: Z�,;� _ ���_��-., . <br /> ���'� ��"ti.��[C�., CONTACTEMAIL: f <br /> �J�''"�r'�/'�. '�..�.�`-ii��'w�'u`..�' � G�F�C�.C.c;�f`�. <br /> AGF�ENENT.�T h2reby cert;'fjr that/have,�ead and ex2m.ined,nis al,,o?ica6on 2nd krovr!h=same to be tru2 and correct A;I pro✓�sicns of/aVrs and ordi:,ances gov�m.ing t'r,is <br /> t�pe of wo�k Y7II6e com;�'et�d wdether soeciFed he�ein or not The granting of a permit dces nof presume io give aufnoriiy to vro/ate or cance/the provisions ci any other szafe or <br /> loca!lasv regu;a?ing const.Zcfion or ihe perfermance of construction. That 1 sm autho,�ized 4y tne oU�ne�of this propery to parform fhe work for which,2pplication is made and l <br /> ccmply with the Sfate Cor,fractors Law 18.27 RCl✓and 296.200 V�qC. <br /> Ci'ry oi Everett O��icia!Use Or,ly <br /> FEE �`"— <br /> � ��z •� <br /> 1 <br /> , <br /> ; <br /> PERMIT# <br /> `�' � E o� J �5 <br /> %� ;3 .z i <br /> O ner/Auth ized Agent Signature a:z <br /> {Revised 10/12/2015) <br />