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�ECTRICAL PERMIT AF�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 />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $� ��. <br />NUMBER OF DEVICES if low volta e: <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # if a licable : <br />DESCRIPTION OF WORK: `(V��w O �j — . <br />�� ITEIL Er'ol�R� 2$O HE Mc�put,�S Ot� �vc� <br />1 (�K- �N�'R�, �/15200 9�_ S�- ►�1 t� �i� <br />CONTACT INPORMATION <br />OWNER NAME: ��e1 �-�� ���.-6% ��� TENANT NAME (If Commercial): P'\ 6�,r <br />OWNER MAILING ADDRESS: sTReEr � �' d22UC1�-�� AY� <br />CITY �v`��� STATE Vv/'� ZIP `I O L�� <br />OWNERPHONE ��L.S 2.5�= �905 OWNEREMAIL: �����rtd�l'�(lSl�i. CO <br />CONTRACTOR NAME: �E.ST�(Z(� �(��� �4�� <br />CONTRACTOR ADDRESS: sTReeT �{ Qy , pfV� ��� S� <br />CITY ��l�V� � C� q i�� V� STATE �/ �+��0, ZIP ���Z� <br />CONTRACTORPHONE: (Db %��—��5� CONTRACTOREMAIL: �N���We.Si�..YrISo�GLr'a�'l�. c71'V� <br />CONTRACTOR LIC. #(REQUIRED): �N�S�t.S �$�� �i� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): C7 �J� ( S'�j <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ?��j� �Q-( � � ��j� <br />�-��� 1 ���� CONTACT EMAIL: �a-� � � �S � � �. o i1G, <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same fo 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 fo give authority to violate 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 I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature <br />�+ �s� a� <br />Date <br />City of Everett Otficial Use Only <br />FEE � <br />����� <br />PERMIT # <br />E �- �L �� `� �% <br />(Revised 10/12/2015) <br />