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0 <br /> IPLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: s 1 Q a /Illi ? k�CdV `A% I/ ---W -A _ "t IJE4�� V, A q9'20 4 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) Z-6 006- SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: -;LS ->S 97f 9L <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1,5i2'— <br /> NUMBER OF DEVICES (if low voltage): a Vo(; S (T <br /> FIRE ALARM? ❑YES ❑ NO 1�� <br /> ASSOCIATED BUILDING PERMIT# (if applicable): '/v �AI/V �.�JL L Vf L <br /> DESCRIPTION OF WORK: �/(QN F OLD Pf AJ tJtVE L., LET-(1-S <br /> J IA S Z U0 LIS 1 as-t <br /> CONTACT INFORMATION <br /> OWNER NAME: '2 TENANT NAME(If C�iommercial): J) C-fR <br /> OWNER MAILING ADDRESS: STREET k) WA -t—A <br /> CITY q_A_ STATE 1e2z74ZIP <br /> OWNER PHONE: 2n6 q 4- 6 OWNER EMAIL: <br /> CONTRACTOR NAME: (21: s UN S (ClK/ <br /> CONTRACTOR ADDRESS: STREET S T SE <br /> CITY � � STATE ZIP GtJ <br /> 2v e <br /> CONTRACTOR PHONE: LS 7S_ . Q� CONTRACTOR EMAIL: �_ Lp�� ® q O .LD" <br /> CONTRACTOR LIC.#(REQUIRED): }V� r C�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: 20 979 4—k-O C <br /> AGREEMENT.'T 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 <br /> type 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/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/ thorized Agent Signature Date (Revised 10/12/2015) <br />