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�.ECTRICAL PERMIi A�LICAiION <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: U�� J�'G (�( G � v� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: COMMERCIAL <br />USE OF BUILDING: � � � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �� <br />NUMBER OF DEVICES (if low voltage): 7 W� <br />FIRE ALARM? ❑ YES L.{3"NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � I SCO N��G T N� �R. L.G� N d�1 �G � C J2 I% F` I�, <br />t� �D N S� lD �l �- S U C��"T � L o t� oc, '�� G� ad� T 1��1- • <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): % � (> /� G�. <br />OWNER MAILING ADDRESS: s�ae� <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: O� T1: � L��G ��-) C V�J C. <br />CONTRACTOR ADDRESS: sTReer ( J� L( �j �� C T�c� <br />� CITY � STATE IP <br />CONTRACTOR PHONE: QJ' 6O—�� �" � 3� CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): O 1�I �1J CITY OF EVERETT BUSINESS LIC. #(REGIUIRED): � �( <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �j6o _ 7� 7 _--' �/J <br />C� J�/"� �O /QU �� CONTACT EMAIL: <br />AGREEMENT.• T hereby certify that 1 have read and examined this applicafion 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 grve authority to violate or cancel the provisions of any ofher sfate or <br />local law regulating construction or ihe performance of construction. That 1 am authorized by the owner of this properfy to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�� - <br />Owner/Authorized Agent Signature Date <br />. ��_�o�� <br />City of Everett Official Use Only <br />FEE <br />� � _ � �: ° <br />PERMIT # <br />E � C�O� -�- � �o � <br />(Revised 90/12/2015J <br />