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� <br />�� <br />�ECTRICAL PERMIT AP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W^ 9a201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: ?j7pZ.3 V�.�'y� p� <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: �,Q, �zi, ( I <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): �/t� S o pc%i (�`raC. <br />OWNER MAILING ADDRESS: srReer % 3 /RvG�v (f,E <br />CITY ,� (/CrZ i• STATE (�[/ / ! Zip �O 2 �'/ <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: ���tG� S GGL��/Z«P ��/i�G�S �hC <br />CONTRACTOR ADDRESS: srReeT J � /) Cr S L-�,- /� ZpL'tl.� <br />CI'fY � (/'e STATE �� • ZIP ( (�� UTJ <br />CONTRACTOR PHONE: 2�06 ^ �^ 3 SS CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): SOiJi�C�SS �%(a ��I CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 5a� �� <br />PRIMARY CONTACT: ❑ OWNER I�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: a v6 —��'� S <br />�(�� j,(�� �T( CONTACT EMAIL: <br />AGREEMENT: T hereby certdy that I have read and examined this application and know the same to be true and correct. All provrsrons of laws and ordinances goveming this <br />type of work will be completed whether specified herein or not. The granting of a perrnit 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 I am authorized by the owner of ihis property to perform the work for which application is made and I <br />comply with the State Contractors Law 18.27 ftCW and 296.200 WAC. <br />']^ <br />i , <br />r I '�� , <br />T/iz/r �, <br />Owner/Authorized Agent Signature � � Date <br />City of Everett Official Use Only <br />FEE <br />� ���� <br />PERMIT # <br />E �1��� OG,� <br />(Revised 10/12/2015J <br />