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L�CTRICAL PERMIT AP�ICATION <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 INFORMATION <br />PROJECT ADDRESS: i � %v/ <br />BUILDING AREA (if res� ential, new construction, remodel, or addition) SF <br />BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: <br />CONTACT INFORMATION <br />OWNER NAME: �J �� � Jt� t� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReer �� �, /�7� l � <br />CITY �- STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: J � G � / G- <br />CONTRACTOR ADDRESS: srREEr � � � <br />CITY �� STATE �/r ZIP �� � <br />CONTRACTORPHONE: —Z S".��?jC� CONTRACTOREMAIL: f/SCGE�'i2�C � /'7`'�. � <br />CONTRACTOR LIC. #(REQUIRED): � („ ��—� $ lv C3 L CITY OF EVERETT BUSINESS LIC. #(REQUIRED): BS;3-7 4� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: y� _ 2[jco� _�J S 3� <br />���- �/� �L���S CONTACT EMAIL: �, j �L� G� 2 �G � �e ��L� � � <br />AGREEMENT: T hereby certify that 1 have read and examined this application and know the same to be true and correct. AU provfsfons of laws and ordmances governfng thls <br />type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violaie 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 1 <br />comp/y with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />� <br />Agent Signature <br />o� i� si.��.� <br />Date <br />City of Everett Official Use Only <br />FEE <br />�,Cj-0� <br />PERMIT # <br />E ���D _ ��5 <br />(Revised 10/12/2015) <br />