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���iRICAL PERtV�Ii �LIC�►TION <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 INFORMATIAN <br />PROJECT A�DRESS: �-� � ( ��(A � <br />BUILDING AREA (if residential, new construction, remodel, or addition) �� �`� �7 SF <br />BUILDING TYPE: ❑ SFR-DETACHED � SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDWG: j,,��. � `��;;;,, - <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $�,0� G <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES � NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: pl • .�� ' J C"✓) t'� �� '� �-. y�- b^� . C; ����� <br />� c'r � �` �:G�.: <br />CONTACT INFORMATION <br />OWNER NAME: c��� ��� TENANT NAME (ff Commercial): <br />� f . <br />OWNER MAILING ADDRESS: s-rReeT �-- � o} �'i�tt 1-Z � ' <br />CITY �'til'� �'�('�� � STA7E G�l� ZIP J� ^J� � <br />OWNER PHONE: OWNER EMAIL: <br />....._. _... ...._ .._.. .._._.....__...___. ..._ .__ _ .._.._.._ __ _ _ . ... ......... ....... . . ...._...._. _ . .. . . ._. . _ _.. . _ _ ._._. _. . .., ....... .._..,., _,.....__._.. <br />CONTRACTOR NAME: �'�G G l�c, �\ C'f <br />CONTRACTOR ADDRESS: sTReeT } <br />t� c7 L �r�c� � q <br />CITY � " � STATE �V'ri ZIP � � �� �� <br />CONTRACTOR PHONE: ���-�� -3�`c'�- ja CONTRACTOR EMAIL: C`'lGt `-� �� y�� G ci � m �,�.,,� <br />CONTRACTOR LIC. #(REQUIRED): C ��, �� ? j�d S CITY OF EVERETT BUSINESS LIC. #(REQUIRED): ��� O� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � J (�' � � ` CONTACT PHONE: Z-� �J _- ' C1 � - rj�J'�. <br />\ CONTACT EMAIL: <br />AGREEMENT.� T he�eby certify thaf I have read and examined this application and know the same to be irue and correct. All provisions of /aws and ordinances goveming this <br />type of work will 6e completed whether specified herein or not. The granting of a perrnit does not presume to give authonfy to violate or cancel the provisions of any other state or <br />local /aw regulating consfruction or the performance of construction. That I am autho�ized by the owner of this properfy to perform the work for which applicafion is made and l <br />comply with the Stafe Contractors Law i8.27 RCW and 296.200 W,4C. <br />orized Agent Signature Date <br />City of Everett O�cial Use Only <br />FEE <br />� ��Q ��� <br />PERMIT# <br />� I�Q1�i� <br />(Revised 10/12/2095) <br />