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(P) 425-257-8810 <br />�ECTRICAL PERMIT A�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � �� � i..� � ; i'�.L .�� .' � � <br />_ � <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 volta e): <br />FIRE ALARM? ❑ YES 'NO <br />ASSOCIATED BUILDING PERMIT #(if a licable): <br />DESCRIPTION OF WORK: � � (� �. � (,�11( (T -��C),i�. N- F_ f�' � - �-1 �-�-� tJST � L, <br />CONTACT INFORMATION <br />OWNER NAME: � �� � �/,,f� � TENANT NAME (If Commercial): <br />OWNER MAILINGADDRESS: sTaeer.�� ���- I( Y�,� ;I�Vi �� <br />CITY ,J/ �'� STATE �' `�" ZIP � �C�" v % <br />OWNER PHONE: �`I �� ��� � lC� �1 1-' OWNER EMAIL: <br />CONTRACTOR NAME: �� I `� � �'� G'( (/1/��_= <br />CONTRACTOR ADDRESS: sTReEr �� I� 7i7�U�` :�� S� •t-� <br />CITY J�M� I/�" � Gt, � ��N ��G2- �-J� STATE y v� ZIP � ��/ '"I ?j <br />CONTRACTOR PHONE: �'i�'� ��� ( � � I 3 �l CONTRACTOR EMAIL: I ✓� �ti C-� !!) ( (� e ( jULytr •� L p;�� �-i �Y t - CU <br />CONTRACTOR LIC. #(REQUIRED)��'I�VI k"=-� �`(c7S�1J CITY OF EVERETT BUSINESS LIC. #(REQUIRED): L��Z�G� � <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE:� �—�] �-'1 I,J C"� <br />� G�� ��-�.�� 1'1./'i�bvi i Z CONTACT EMAIL:1�� l,� F�Ge.W�_Cc��''.;{�'�—�. �,E;�'1i� <br />AGREEMENT: T hereby certily that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />rype of work will be completed whether specified herein or not. The granting of a pe�mit does not presume to 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 ownei of ihis property to perfoim the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />fi� �n� � <br />��-__ _j �� i�,�� , � . � � � � <br />�orized Agent <br />Date <br />City of Everett Official Use Only <br />FEE <br />������ <br />PERMIT # <br />E1�0�'�25 <br />(Revised 10/12/2015) <br />