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� <br />� <br />�ECTRICAL PERMIT AP�CATION <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: �' �^t:�i1�, • � � � �� � �,, ��t: '�� �. �' � ( <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX L�3"MULTI-FAMILY -# OF UNITS:� ❑ COMMERCIAL <br />USE OF BUILDING: � �;�;r-�,^1e;� <br />CONTACT INFORMATION <br />OWNER NAME: p v� � ���r1 ,�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT `Z���jl ��� �,��Zd� <br />CITY � STATE � ZIP �,J (a � <br />OWNER PHONE: �' Z�J `, ^� �'j OWNER EMAIL: <br />CONTRACTOR NAME: �CL � ��fn � rM <br />CONTRACTOR ADDRESS: sTREET ZC� �jU J`-t�l' �r � ct � <br />CITY � T , � , STATE R ZIP `�, � � <br />CONTRACTOR PHONE: (� �jZYj '- 1 �JC)C' CONTRACTOR EMAIL: � �.� `t ��t �v�c tp:� c:`�-+-. - �.9�`^ <br />CONTRACTOR LIC. #(RECIUIRED): � R t-t� Z�UZ� � CITY OF EVERETT BUSINESS LIC. #{REQUIRED):� ZFj�jU�( <br />1 <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR Gd�OTHER (Please Specify) rrJ"� ��' Cs�O �':-�� v�c.cl o C' <br />CONTACT NAME: CONTACT PHONE: ��j •�- 3 - 5 U� <br />�c.lvlv� y O(��.�U.� CONTACT EMAIL: �.; '"�i � ` vJc �iv� -F�,n ' 1Ct�' !"� .C..pM <br />AGREEMENT: T hereby certi(y that I have read and examined this application and know the same to be true and correcL All provisions ot /aws and ordinances governing thls <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 other state or <br />local law regulating construction or the performance of construction. That / am authorized by the owner of this property to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />! �. � -� <br />i <br />� <br />; - <br />/ � � �� <br />Signature Date <br />City of Everett Official Use Only <br />FEE <br />�� ����� <br />PERMIT # <br />E r �� � os�r <br />(Revised 10/12/2015) <br />� <br />