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�..ECTRICi4L PERMIT AI�LICATION <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 />PROJECT ADDRESS: �� ���j , �x1 � `"�' Y"j/�-y-� �� <br />BUILDING AREA (if residential, new construction, remodel, or addition) l 7'J�"G' SF <br />BUILDING TYPE: ' DETAC ED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: � _ ,�,,�: , � <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE QF WORK: $ �p��� v <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESC IPTION OF WORK: C 7 �x ��5' �.� ,� <br />< <br /><� �� <br />CONTACT INFORMATION <br />OWNER NAME: ({,' �� .� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREET �' �� �p s.l�� 5 5 �� v� S t <br />CITY /i� Y`f f-� STATE �JO� ZIP <br />OWNER PHONE: lD / 7"`i �'- � b`j OWNER EMAIL: <br />CONTRACTOR NAME: � � � � � � ' � � L G G <br />CONTRACTOR ADDRESS: sTReeT /�C� �-,� l �l �� J�Z /'V"/— <br />CITY �� / STATE it. ZIP U �"� <br />CONTRACTOR PHONE: °� .7 `� - y �j - �' CONTRACTOR EMAIL: �,f ' n � ; 1n - ' { _ �,`,� <br />CONTRACTOR LIC. #(REQUIRED): i r YY�t,'� J`� �j j Gc C� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �� <br />PRIMARY CONTACT: ❑ OWNER C�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: /� .=j — L� � ,. �� �-� � <br />���� �/f / - ,� CONTACT EMAIL: <br />AGREEMENT: T hereby certiiy ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this <br />type of work will be completed whether specified herein or not. The graniing of a permiE does not presume to give auihority to violate or cancel the provisions of any other state or <br />local law regulating construction o� the performance of construction. That l 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 />� / ��� -� -� <br />orized Adent S'_ nature Date <br />City of Everett Official Use On/y <br />FEE <br />��1 � a�, <br />PERMIT # <br />E I� �.- �l I <br />(Revised 90/12/2095) <br />