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E�CTRICAL PERMIT APPLILATION <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 /> _ � , <br /> PROJECT ADDRESS: 1 G'�'(`� , x ' f' �' .�1��. �' � ,�' � � 1 ' ;'ti � � <br /> BUILDING AREA(if residential, new construction, remodel, or addition) � � � ' ' S�'-' <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX �.MULTI-FAMILY-#OF UNITS: I � ❑ 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 applicable): <br /> DESCRIPTION OF WORK: � '�� � �2..� --E� � O D � /� /Z o �. �'� ?" <br /> , <br /> ,��,'? �=c ,' .;�. i� r �r' r S � c�1�r -�" Qa!�l ./u � �Y" � �i.�'>:' > <br /> (�(.' ��—% �'' F. +..�" .� <` .� f . . �.,, ,/�F•• f' � f V�. , ` _' � <br /> .� <br /> .,-' ..�" � ��� `f?. �.1-.•� 1 ..n� J <br /> CONTACT INFORMATION <br /> OWNER NAME: � � � � � `� ' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS:�1'��yTREET � � � r:;? � �'� r �� � <br /> �y..-� �' ' : <br /> (C.�. ,�� � i �t.:' t - CITY STATE 4 " � ZIP � f� , . . <br /> OWNER PHONE: 7 2-s— 3�� ' ( 2 ��%� OWNER EMAIL: <br /> CONTRACTOR NAME: aQ r/t/� �Y"� � �I-{>� � L 1/ � �l�l 5 (^c�;��f,> �,d'iJ'C- t U/•!' G�.L-.� • <br /> CONTRACTOR ADDRESS:Z�'z a sTReeT I���� ' �� �_ �, � (� �-- <br /> 1 l'-� � /, 1 `� ' <br /> CITY d 0/'+ T�' � STATE �lJ � ZIP � �. <br /> CONTRACTOR PHONE: �? �' !% , � �;'� `(5�f C CONTRACTOR EMAIL: '�C'�":,�1�+,�F" �" ` ��c'�' � �"t � , �!'�^7` <br /> CONTRACTOR LIC.#(REQUIRED): /� ��� �1 �I(� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O,�ZSOO <br /> PRIMARY CONTACT: ❑OWNER .020NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: � ���t� �' � `u,' r k '• , CONTACT PHONE: 2_C?� -- 4` ,"�< �./�' S,` �? <br /> � r�� �. t :•.�. > ,� �. <br /> CONTACT EMAIL: K �%'/`�' r�c. .< �, ; r,.. e'F'� ��-` � �„ [ � L��4:' ' <br /> AGREEMENT:1 hereby certify 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 type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cance/the provisions of any other state or <br /> local law regulating construction or the pertormance 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 /> _` City of Everett Official Use Only <br /> 1 <br /> PERMIT# <br /> i <br /> , . 2 � y � � E y ;�.,,J� � � J % <br /> , <br /> Owner/Authorized Agent Signature ate (Revised 9/23/2016) <br />