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� ECTRICAL PERMIT A�iLICATION <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 />PROJECTADDRESS: ��G� 'Ta.t�c:;'�-•� `�J j`��G �,r-t z w .°'t �'^���" ,� � <br />�1, �. <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: �.t„`- �r' !`�%rt � l� ` _•. <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ ) j� � iJ "G� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � � J P <br />t i �' �� i%�� I'�� G"�1L-C G'L' t "�� d d�'� G 1"ti �� r <br />CONTACT INFORMATION <br />OWNER NAME: ° E� �?� �•!�,�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReEr � ���f-- ,�)" <br />ciTv ,;��-� srnTE yj/ ziP P'�'� E3 <br />OWNER PHONE: ':��j �%•--a�if�f� OWNER EMAIL: � � � •r y.. � , , ,�, •/1 <br />CONTRACTOR NAME: �- � � �iy� . �c ..L r :�(� , <br />CONTRACTOR ADDRESS: sTREeT Q 'r �,.� '� �L�G� <br />CITY ,��; /a.� STATE (,' � ZIP L �I � <br />CONTRACTOR PHONE: �/JL �j �� '- 0%�i': CONTRACTOR EMAIL: ��'� l,� � ����c �� , <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />Ry�j �tiE,�}.I � sL�, � CONTACT EMAIL: �y% ��/ ,�, ,n, t�,e l=.d r'✓l_ <br />AGREEMENT: T hereby certify thaf I have read and examined this application and know the same io be true and correct. All provisions of laws and ordinances governing this <br />fype of work will be completed whether specified herein or not. The granting of a permif does not presume to give authonty to violate o� 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 applicafion is made and l <br />comply with the Stafe Confractors Law 18.27 RCW and 296.200 WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />FEE <br />�1�,�� �� <br />PERMIT # <br />E 1 � 02-- ���i <br />(Revised 10/12/2095) <br />