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� <br />� <br />E�TRICAL PERMIT APPLI�ION <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: � Z ���� �-� � �� � � V�Ir�.- N �--= <'� �'�� �— i-� �� <br />BUILDING AREA (if residential, new construction, remodel, or addition) 2>>� SF <br />BUILDING TYPE: O SFR-DETACHED ATTACH�D O DUPLEX O MULTI-FAMILY - ii OF UNITS: O 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? o YES o NO <br />ASSOCIATED BUILDING PERMIT #(if a licable): <br />DESCRIPTION OF WORK: �'� � C \ c-�L_ �1 � �� �� � C� � � L�1 <br />CONTACT INFORMATION <br />OWNER NAME: 'L� � 1 l�� l. V���"�: �! �_ !�-� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srRe�' Gi �� C I `'n_ -�^l 'Y— �:-__ <br />`/ � G }� <br />GTY �� �� / V r STATE �✓ `I �^� ZIP t Y�� �- �:-' ` <br />OWNER PHONE: i1�� � �1 ���I �2 OWNER EMAIL: <br />CONTRACTOR NAME: �-7I ��'.-1/li`-�_ <br />J r � <br />CONTRACTOR ADDRESS: sTaeeT � � 4 Z�%"`\� �� �'~� - <br />CITY '�✓ `'�J'.�' I''�.-. - ;. �'..',�!�. . �-_V M L�" 1 �— STATE li�i �\ ZIP �� i�' \.�5' � <br />CONTRACTOR PHONE: �-'� � � �% � �� � <br />�, I' 1 ! CONTRACTOR EMAIL: I \ 1���( ' � ii `-�1_t' �v'-I'1/'�f' ( ; �'?�� i��� � ,i10' <br />CONTRACTOR LIC. #(REQUIRED): �� L�% �" !� I-1 `(':� �' \, )`-:i CITY OF EVERETT BUSINESS LIC. #(REQUIRED): O�, 2. -G( <br />PRIMARY CONTACT: O OWNER (� CONTRACTOR O OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ' z�- � � —� l'� C� <br />-- � l.� !/VVl''v'1 ��.�, �;iv��_ t�Z� CONTACT EMAIL: �i� .rl���) C�. � G��_-�'?�=,:�j i� <br />AGREEMENT: T here6y 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 />type of work will be completed whether specified herein or not. The granting of a permit does not presume to give aufhoriry to violate or cancel the provisions of any other state or <br />local law regulating consiruction or ihe performance ot construction. That I am aufhorized 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 />_-'� % <br />% . �, �� `-� ( �'� ( p �� <br />�. - <br />Owner/Au orized Agent S�nature � Date <br />�/ <br />Ciry of Everett Official Use Only <br />FEE <br />� <br />�, �j <br />PERMIT # <br />E II�G�i��S� <br />(Revised 10/12/2015) <br />