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�.ECTRICAL 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 />PROJECTADDRESS: �(p`� VG�ZS l�v2���. LV�/�l w� �`dLv, <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: �E 7i G P✓l}�u <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ � ��U <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � ���-c Q �,rv:ce. '�0 32��� c�� Z���i .ne� L���f Q <br />CONTACT INFORMATION <br />OWNER NAME: ��/ -� C���n �� � f" TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREeT (j �- �ct � 5 .� <br />I'1}-�.�y)/��- !,C� b <br />CI71' G�e��, \ STATE W" ZIP `�1 pZ <br />OWNER PHONE: �jO `Z�h "�j9j%O OWNER EMAIL: C�'1f �7 , Wia-�� 1 ." j� w��=� . Co ��1 <br />CONTRACTORNAME: �-��� I(; �'-eC`f�C. <br />CONTRACTOR ADDRESS: sTReeT � ZZto I� �I � �We /v C <br />CITY L� �� ��QJ� � 7 STATE "" � ZIP _ ` V �� • <br />CONTRACTORPHONE:LZS Z�'I`'L' Sst CONTRACTOREMAIL:7�'�`����- `{ M Sw•�� �- �'��r�L -C�✓'� <br />CONTRACTOR LIC. #(REQUIRED): Jw ���-GL� lO P� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 'JS�� J[ <br />PRIMARY CONTACT: ❑ OWNER .L�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � Z� -�j�(� "C( ��S�j� <br />3�,,� Lr_��Z7o�n <br />`�`` CONTACT EMAIL: �r .� �l �,, $�„�, c ele�^J`�, .Lo:^'� <br />AGREEMENT. T herebvi certifv that 1 have read and examined this aaplication and know the same to be true and correct. All provisions of laws and ordinances poverninp this <br />type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any ofher 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 />comp/y with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Agent Signature Date <br />City of Everett Official Use On/y <br />FEE <br />�' �0 � � <br />s <br />PERMIT # <br />E ��"1"� � <br />(Revised 10/12/2015) <br />